Category: Medical Billing

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
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Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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Optimize Billing Practices with Medical Billing Audits

A domestic medical billing audit is an operation that inspects and estimates the value and dependability of clinical documentation and the overall medical billing process. This technique closely examines health records upheld by the practice and evaluates medical billing data presented to the payers to make sure that the practice picks out, observes, and rectifies […]
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12-Point Medical Record Checklist : What Is Included in a Medical Record

12-Point Medical Record Checklist : What Is Included in a Medical Record

A medical record is systematic documentation of a patient’s medical history and care. It usually contains the patient’s health information (PHI) which includes identification information, health history, medical examination findings, and Medical billing information. Medical records were traditionally kept in paper form, with tabs separating the sections. As printed reports were generated, they were moved […]
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Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]
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Why Healthcare Providers Need Medical Claim Clearinghouses

Why Healthcare Providers Need Medical Claim Clearinghouses

Medical claim clearinghouses enhance the efficiency of claim submissions for healthcare providers, thereby reducing costs and improving payment accuracy. Each year, healthcare payers and providers exchange billions of claims to finalize patient encounters, a number that continues to rise. As claim volumes increase annually (except for a dip in 2021 due to the COVID-19 pandemic), […]
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Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

The Centers for Medicare and Medicaid Services (CMS) recently updated guidance on the use of 340B modifiers by Medicare providers and reimbursement providers for drugs Part B biologics and the 340B Drug Enforcement Program. Published participation. The purpose of this rulemaking is to inform all provider types about the newly amended 340B requirements for 2024 […]
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5 Essential Tips to Reduce Accounts Receivable Turnaround Time

 When your medical practice submits a claim to a payer, the countdown begins until you receive the payment. Ensuring timely payment is crucial for your business, as delays can have costly consequences. Ideally, you should aim to clear accounts receivable within 30 days. To effectively reduce accounts receivable, it’s essential to implement efficient billing processes, […]
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Navigating Outsourcing Vs Offshoring in Medical Billing: Explained

Navigating Outsourcing Vs Offshoring in Medical Billing: Explained

Outsourcing Vs Offshoring in Medical Billing: Targeting Cost Savings with a Global Reach: Both medical billing outsourcing and offshoring involve delegating billing tasks to another entity, but there’s a key difference in their destination: Medical Billing Outsourcing: In general outsourcing, the Medical Billing company can be located anywhere. It could be in the same state, […]
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