In March of 2020, the CDC asked physicians to provide non-essential care with virtual care in order to reduce the risk of COVID-19 exposure. But now post-pandemic landscape, many physicians have adopted virtual solutions in order to provide quality care for marginally healthy groups. Virtual care gives physicians risk-free, reliable ways to offer non-essential care […]
For most providers, the revenue cycle process means submitting claims and wait for payer reimbursements. These providers are under the impression that if they submit the claim, it will get paid but that’s not the case. Revenue cycle management includes really crucial processes like provider credentialing and contracting, Benefits verifications, prior authorizations, and out-of-network billing […]
Recoupment and Refund Recoupment is a request for a refund when an insurance company overpays an account. On the other hand, a billing refund is a technical process of returning the excess money in the specified amount that the party, medical provider, patient, or other responsible parties owes according to the recoupment request. Some of […]
The Healthcare Financial Management Association (HFMA) defines Revenue Cycle Management (RCM) as all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Revenue cycle management (RCM) is the financial process related to a patient’s clinical encounter. According to HFMA, a basic role of RCM is to measure how […]
Medical billing on its own can be a complex process, requiring specific expertise. However, substance abuse billing comes with unique challenges even for certified billing and coding experts. Substance abuse billing is one of the major areas with which drug and alcohol addiction treatment centers struggle resulting in lost revenue and delayed payments. Many drug […]
In a perfect world, all submitted claims would be processed correctly the first time. In the world of medical billing, however, we know this is not always the case. Even after cautiously submitting a claim it may get denied. Handling claim denials can be a frustrating, time-consuming, and complicated process. Knowing some basic strategies for […]
Centers for Medicare & Medicaid Services (CMS) defines coordination of benefits (COB), as the process which allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities. In simpler words, COB determines which insurance carrier is primary, secondary, and so forth. This coordination between insurance carriers exists […]
Current fact suggests, nearly 6 in 10 patients either rarely or never received an estimate of out-of-pocket costs before they received treatment. As per a survey report from TransUnion Healthcare, 75 percent of patients mentioned that they can play better if they receive pre-treatment estimates of out-of-pocket costs well in advance. The healthcare experts agree […]
Eligibility and benefits verification is the first and most significant step in the medical billing and coding process. Today’s continually changing and increasingly complex healthcare environment requires, more than ever, close attention to validating coverage, benefits, co-payments, and unpaid deductibles. With the eligibility and benefits verification process in place, you can collect more accurately. Thus, […]
Sometimes, you are so focused on delivering the best patient care, it causes key medical billing mistakes. Whether it’s submitting paper claims, not having EOBs for all claims, not understanding denial reasons, not following up on claims, not reviewing clearinghouse reports, and the list goes on. Unfortunately, failure to follow payer policies and reimbursement guidelines […]
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