Reducing E/M Services Claim Denials

E/M Services Denial Reasons As per the Centers for Medicare & Medicaid Services (CMS) data, approximately 15 percent of evaluation and management (E/M) services are improperly paid and accounted for almost 9.3 percent of the overall Medicare fee-for-service improper payment. Some of the common denial reasons are ‘similar services from multiple providers in the same […]


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Making a Stronger RCM Team in 2022

A recent survey of U.S. healthcare organizations highlighted declining reimbursements as a top industry challenge. The COVID-19 pandemic changed payer billing guidelines, and reimbursement policies made receiving accurate reimbursement tougher. Reimbursement complications often lead to documentation and coding inaccuracies leading to increased claim denials. The healthcare reimbursement process requires complicated steps and, at each turn, […]


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Surprise Medical Billing for Anesthesiologists

Basics of Surprise Medical Billing Out-of-network billing, or ‘surprise medical billing,’ occurs when a patient receives a bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductibles. These bills can be unanticipated by patients, who often assume that facility-based providers, including anesthesiologists, are […]


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Basics of EDI Enrollment with Medicare FFS

What is EDI Enrollment? For a provider is trying to enroll with Medicare FFS, they must first establish an Electronic Data Interchange (EDI) agreement with Medicare. EDI is the process of using nationally established standards to exchange electronic information between business entities. The Department of Health and Human Services (HHS) adopted certain electronic standards for […]


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Improving Bottom Line of Your RCM

Revenue Cycle Management (RCM) is defined as the process of handling claims, processing payment, and generating revenue for your practice. It includes all functions associated with different steps of medical billing, beginning from the time when a patient makes an appointment and ending after all the claims and payments have been collected and the balance […]


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RCM Strategies to Improve Practice Revenue

Your medical practice revenue is driven, impacted, and influenced by Revenue Cycle Management (RCM) strategies. It includes claims management, patient payments, and your in-house billing workflow. Without implementing these strategies, providers might find it difficult to maintain high levels of clean claims, adjust to an increasing dependence on patient payments, or manage their billing effectively. […]


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Effective RCM Strategies to Collect Maximum Patient Responsibility

Patients’ financial responsibility is on the rise as more patients are choosing high-deductible health plans (HDHP). Increasing patient responsibility is an ongoing trend that does not seem to be slowing down in the near future. Providers report many challenges with responding to growing patient financial responsibility. Given the increased payment responsibility, being able to determine […]


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Effective RCM Strategy to Increase Reimbursements

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 […]


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How to reduce hospital claim denial rates in 2021?

The recent COVID-19 pandemic has accelerated claim denials from payers. According to a recent analysis, the average rate of claim denial is increasing by 23 percent in 2020 compared to four years ago. Faults related to missing or invalid claim data, which included unspecified billing issues, missing or invalid explanation of benefits, and service not […]


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Efficient RCM Process is the Key to Provider Success in 2021

To overcome the financial impact of pandemic, providers need to measure and focus on an efficient RCM process to get success in 2021. COVID-19 pandemic has a severe impact on the healthcare industry, caused healthcare providers to depend on efficient RCM process to maintain financial stability in 2021 and henceforth. What is RCM Process? Revenue […]


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