3 Signs that Show Need of Outsourcing Revenue Cycle Functions

Healthcare providers are under increasing pressure as more and more patients are shifting to value-based care. Providers are already under pressure as they have to deal with declining reimbursements, higher risks, and tighter margins while improving patient care. Due to this, hospitals and physician practices of all sizes are being forced to re-examine their revenue cycle […]

Analyzing Claim Denial Trends for 2020

Cause of claim denials and trends analysis by MBC

Hospitals are receiving more claim denials from payers, with the average rate increasing by 23 percent in 2020 compared to 2016, according to a research report conducted by Change Healthcare. The analysis includes 102 million hospital transactions valued at $407 billion in total charges across more than 1,500 U.S. hospitals. Since 2016, the denial rate […]

Improving Medical Coding Quality

Even though medical coding plays a crucial part in revenue cycle management, it is the most neglected process of medical billing. As per the study report, documentation and medical coding are considered to be the weakest processes of the revenue cycle in 2019. Accurate medical coding will ensure the claims will get out the door […]

Diagnosis Coding Guidelines for Aftercare

Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. Post-op care is different from aftercare. Post-op care falls into this category of care when the condition that precipitated the […]

Preventing Revenue Leakage in Your Practice

Revenue leakage is nothing but the lost opportunity to collect money earned from your practice. The reason for revenue leakage can be rejected claims, unbilled claims, unbilled procedures, credentialing-related denials, underpayments, and outstanding patient balances. For any healthcare practice, medical billing and revenue leakages could result in significant loss because of long payment cycles. There […]

Billing Guidelines for Global Surgery Modifiers

The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the pre-operative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in […]

Understanding ‘Separate Procedures’ in Surgery

Defining ‘Separate Procedures’ According to CPT® surgery guidelines, some of the procedures or services listed in the CPT® codebook that are commonly carried out as an integral component of total service or procedure have been identified by the inclusion of the term ‘separate procedure.’ The CPT codes designated as ‘separate procedure’ should not be reported […]

Preparing Your Practice for Value-Based Care

What is Value-Based Care? Unlike traditional ‘fee-for-service care models that link payment to the number and type of services utilized, value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Value-based care differs from a fee-for-service or capitated approach, in which providers are paid […]

Understanding Comprehensive Care for Joint Replacement (CJR) Model

In line with the Obama Administration’s efforts to provide high-quality care while reducing costs, in April 2016 CMS announced an initiative to implement bundled payments for hip and knee replacement surgeries, called Comprehensive Care for Joint Replacement (CCJR). Recently in May 2021 CMS published an 81-page final rule to extend and change the Comprehensive Care […]

Avoiding Healthcare Fraud and Abuse

Providers face multiple healthcare fraud and abuse laws at the local, state, and federal levels. Fraud and abuse cases in the healthcare industry cost billions of dollars a year. Healthcare fraud and abuse situations include submitting false claims; billing for medically unnecessary services; billing and coding errors; billing for services that were provided by unlicensed […]

We Excel In

We Dominate Over

Our Reach

Interesting Reads

Insightful Blogs

Read our latest medical billing services and RCM related blogs