Provider Credentialing Provider credentialing is the process by which an insurance company formally assesses a provider’s qualifications and competency-based on demonstrated competence. Before a provider or organization can bill an insurance company, the provider must first be credentialed by the insurance company. This can be a time-consuming process, and often takes up to six months […]
According to the denial rates report published in February 2021, out of total claims submitted worth $3 trillion, claims worth $262 billion were denied. You will be surprised to know that more than 90% of these denials are preventable. And the worst part is, more than half of these denials were never appealed or resubmitted […]
With patients bearing more financial responsibility for their healthcare, outpatient settings are becoming more appealing—driving demand for optimized Ambulatory Surgical Center Collections. A research report from Bain & Co. estimates that procedures in these centers will increase from 23 million in 2018 to 27 million in 2021. As per the same report, out of all […]
CPT manual section ‘Special Ophthalmological Services’ describes diagnostic tests that go beyond eye exams. These tests may be reported in addition to the general ophthalmological services or evaluation and management services. Diagnostic tests are usually reimbursed separately by most payers. Documentation of diagnostic tests should clearly mention why the physician ordered a diagnostic test and […]
Medical billing is the most important yet underestimated part of your healthcare organization’s revenue cycle. However, there are a few things that are commonly believed about them that just aren’t true! These myths range from considering medical billing as a data entry process to misconceptions about outsourcing. We wanted to clear up some of the […]
During the COVID-19 public health emergency (COVID-19 PHE), CMS expanded the scope of telehealth/ telemedicine services. In this blog, we shared telehealth billing guidelines that are applicable only for Gastroenterologists. CMS increased payment for telephone evaluation and management codes 99441-99443 to the level of office/outpatient E/M codes 99212-99214. These telehealth rules were expanded to all […]
Streamlined revenue cycle operations ensure the financial stability and growth of your practice. When the healthcare revenue cycle is not managed well, collection efficiency drops, and accounts receivable (AR) days increase. Accounts receivable is at the heart of revenue cycle management, as you get paid faster which results in healthier operations. Streamlining the healthcare revenue […]
Back-office revenue cycle functions include claim submission, payment posting, denials handling & resolution, accounts receivable follow-up, and others. All these functions must be taken care of by billing experts to ensure accurate practice collection. Providers have to spend a lot of time on these back-office functions due to high employee turnover, billing and coding updates, changes […]
One of the biggest challenges for healthcare providers is boosting patient responsibility collection. Due to lower monthly premiums, more individuals are choosing plans with higher deductibles and more out-of-pocket expenses for services. This increase in patient portion for medical services is a major challenge for healthcare revenue cycle management. As more patients are opting for […]
Defining Clean Claim A clean claim is a submitted claim without any errors or other issues, including incomplete documentation that causes claim rejections or denials. As per the definition of a clean claim first part is correct to claim information and while the second part is not missing any information. In this blog, we shared […]
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