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Medical Billing

Evaluating the Procedural Constituents of Medical Claim Management Cycle

Given the alarming statistics about medical billing industry average – 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers, 50% of denied claims are never re-filed, and 50-70% of denied claims have higher chance of being recovered – physicians’ reasoning seems to be […]

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Bringing Physicians and Insurance Providers on the Same Wave-length

While physicians and health insurance providers have been indispensable and integral to US healthcare industry, the trust with each other has not been all that convincing – physicians being apprehensive of growing rate of denial and delay of their patients’ health insurance claims, and health insurance carriers being suspicious of physicians’ integrity in medical billing. […]

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Medicare Cuts and Geriatric Medicine

The proposed Medicare cuts by President Obama and the Congressional “Super Committee” does not bode well for physicians and geriatric medicine in the country. Although the cuts would ensure that Medicare bankruptcy would be postponed and the Federal deficit reduced, it has long term negative consequences for long-term care hospitals, nursing homes, home health facilities, […]

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Physicians see value in handling Claim Denials in a Better Way

Appealing denied claims is one of the important steps in enhancing the revenue of physicians and this fact is supported by a report by the U.S Government Accountability office (GAO). The report released on March 16, 2011 states that – “coverage denials occurred for a variety of reasons, frequently for billing errors, such as duplicate […]

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Gearing Up for Inpatient Medical Coding and Reimbursement Challenges

“The prevalence of such demanding challenges is reason enough to push physicians beyond their Medical Billing Management capabilities, which invariably results in compromised medical efficiency. Therefore, physicians – faced with insurmountable challenges of inpatient medical billing management – have either to set up a dedicated team in-house or look elsewhere for competent outsourced solutions.” Unlike […]

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Towards Cleaner Claim Submission and Realization

Despite vigilant system of medical claim submission practiced by physicians, the recent statistics released by the American Medical Association (AMA), has reported an increase in medical billing inaccuracies by 2% over the last year’s results. What is more significant is – apart from delay or denial owing to inherent error-prone claim submission – the estimated […]

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The Relevance of Using Perfect Modifiers in Medical Claims

The overlapping nature of certain medical procedures is such that it is impossible to report them with CPT codes alone. Although CPT coding has grown to be comprehensive enough to cover breakthrough procedures over the years, yet, physicians are not spared from submitting separate procedural forms for medical procedures requiring explanation that overshoot the CPT […]

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Alleviating the Time Factor in Evaluating Revenue Generation from Medical Claims

“While physicians would not mind investing in revenue optimizing systems, asking them to invest their invaluable time in something which is non-core to their medical efficiency could ultimately have an adverse impact on their efficiency for medical care. Therefore, there seems to be a considerable propensity to outsource Medical Billing Management” The rapid healthcare reforms […]

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