As healthcare documentation continues to evolve, the ability to accurately capture procedures performed in inpatient settings is vital for patient safety, proper reimbursement, and compliance. One of the most sophisticated tools used in this context is the ICD-10-PCS (International Classification of Diseases, 10th Revision, Procedure Coding System). Designed for inpatient procedure coding in the U.S., […]
Prior authorization (PA) is a necessary but often frustrating part of the healthcare reimbursement process, and the prior authorization burden it creates is substantial. While insurers use it to manage costs and ensure medical necessity, the administrative burden it places on physicians, billing staff, and patients is immense. A 2022 American Medical Association (AMA) survey […]
In today’s complex healthcare environment, revenue cycle management hinges on one crucial aspect—denial management. With payers constantly updating policies, and medical claims becoming increasingly complex, denied claims are inevitable. However, they don’t have to be revenue roadblocks. By streamlining the denial management process, healthcare providers can accelerate reimbursements, reduce administrative burden, and significantly boost revenue. […]
In the intricate dance of healthcare administration, prior authorization often feels like an unwelcome and time-consuming interruption. The manual processes involved – phone calls, faxes, and endless paperwork – not only burden staff but also create significant bottlenecks that can lead to delayed patient care, increased operational costs, and, critically, a higher rate of claim […]
The rise of telehealth has revolutionized healthcare delivery, offering convenience and accessibility for patients and providers. However, this shift brings its own set of challenges, particularly when it comes to Revenue Cycle Management (RCM). Addressing these challenges effectively through Telehealth RCM Optimization Tips is crucial for ensuring financial health, minimizing claim denials, and maximizing revenue […]
The healthcare industry is in constant flux, and staying abreast of the latest Medicare billing rule updates is paramount for healthcare providers. As we navigate 2025, several significant changes have come into effect, impacting reimbursement, telehealth services, care delivery models, and compliance requirements. This blog post aims to provide a comprehensive overview of these updates […]
Is your outpatient medical billing process feeling more like a tangled web than a well-oiled machine? You’re not alone. In the fast-paced world of healthcare, billing errors and inefficiencies can easily creep in, leading to delayed payments, increased denials, and a significant drain on your practice’s resources. The good news? You don’t have to overhaul […]
On April 4, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Advantage & Part D Final Rule for the 2026 contract year (CY) concerning the Medicare Advantage (MA) program, the Medicare Prescription Drug Benefit Program (Part D), the Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (the […]
The final rule issued by the Biden administration aimed to bolster the privacy of reproductive healthcare data under HIPAA, a significant move following the Supreme Court’s overturning. Health and Human Services (HHS) officials hoped this rule would alleviate the “chilling effect” on individuals seeking or providing legal reproductive healthcare, stemming from both legal challenges and […]
The Centers for Medicare & Medicaid Services (CMS) has unveiled its Fiscal Year (FY) 2026 IPPS Proposed Rule, which outlines significant updates to three key Medicare hospital quality initiatives: the Hospital-Acquired Condition (HAC) Reduction Program, the Hospital Readmissions Reduction Program (HRRP), and the Hospital Value-Based Purchasing (VBP) Program. These proposed changes, outlined in the IPPS […]










