Tag Archives: HIPAA / ACA / ACO

What is an ideal denial percentage? Yes, there will always be some denials

The denial rate represents the percentage of claims denied by payers during a given period and quantifies the effectiveness of your revenue cycle management process. A low denial rate indicates a healthy cash flow. A 5% to 10% denial rate … Continue reading

Posted in Medical billing and coding services | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Received Payer Request for Medical Records? Keep Calm and Take These Steps

If a letter were to arrive at your organization in an innocuous-appearing envelope, you may be afraid to open it. It’s unsettling for a payer to request medical records for claims that have already been paid. It is becoming more … Continue reading

Posted in Medical billing and coding services | Tagged , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Understand Payment Rates and Basics of ASC Billing

An Ambulatory Surgical Center (ASC) is defined by CMS as a facility with the sole purpose of providing outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures done at an ASC are … Continue reading

Posted in Ambulatory Surgical Centers | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Top 5 Compliance Issues for Ambulance Biller

Ambulance service billing involves a host of unique compliance challenges. The ambulance industry has seen a significant number of false claim cases, fraud investigations, Medicare audit activity, and other types of billing-related cases. It is imperative that billers fully understand … Continue reading

Posted in Ambulance Transportation Billing | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

What is the Insurance Credentialing Process?

Credentialing is a process that the insurance companies use to verify your education, training, and professional experience and to ensure that you meet their internal requirements for serving as an in-network provider on their panel. The goal of the insurance … Continue reading

Posted in Medical billing and coding services | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

CAQH and Insurance Credentialing

What is CAQH? Council for Affordable Quality Healthcare, Inc. (initialized as CAQH) is a non-profit organization incorporated in California as a mutual benefit corporation. It is essentially an online portal that stores provider information in a secure, collaboration database.  This … Continue reading

Posted in Medical billing and coding services | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Prominent Ambulatory Surgery Center medical billing functions are affecting your practice revenue

Compliance guidelines that govern the Ambulatory Surgery Center’s reimbursement are wide-ranging, complex and ever-changing. Hence, it’s important for ASCs to hire or partner with Ambulatory Surgical Center billing and coding management consultants who understand the legal rules placed on ASCs, … Continue reading

Posted in Ambulatory Surgical Centers | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment