Category: Blog

Advantages of Claim Scrubbing

Unveiling the Advantages of Claim Scrubbing

Claim scrubbing enables the potential for increased accuracy in claims, enhanced client relationships, and improved patient interactions. Claim scrubbing is the process of identifying and rectifying coding errors in medical claims prior to their submission to insurance providers. Whether conducted manually or through automated systems, claim scrubbers validate medical claims before they are sent to […]
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Automating Claim Processing

Automating Claims Processing in the Healthcare Industry

By utilizing automation, it is feasible to improve the upstream and downstream adjudication process through data validation and routing. The healthcare industry can benefit from automation in almost all administrative functions, but it can significantly improve the auto-adjudication rate. In an ever-changing industry, possessing technical expertise is of utmost importance. The healthcare sector is increasingly […]
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Key to RCM Success

Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

A survey conducted by leading healthcare technology company, revealed the top revenue cycle tasks like denials management, coding, and prior authorizations requiring the most subject matter expertise. Out of 15 tasks listed, over 550 healthcares financial and revenue cycle leaders identified denials management, coding, and prior authorizations as the top choices. Denials management was chosen […]
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Old Medical Code Set

Why Old Medical Code Sets Are Still Essential: A Comprehensive Guide

Remaining current is indispensable in the healthcare industry, yet relying solely on present codes may not always be the optimal solution. When tasked with conducting an audit, handling an appeal, or conducting research on the appropriate code usage for a previous encounter, having a thorough understanding of the code descriptors and guidelines that were applicable […]
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Critical Thinking Skills prvents denial

Preventing Denial with the Power of Critical Thinking Skills

Lately, I’ve been thinking about how to prevent claim denials, especially considering the high number of claims that were denied in 2021. As coders, we can use critical thinking skills to improve the accuracy of our coding and ultimately reduce claim denials. Critical thinking involves formulating questions, gathering information, applying the information, considering the implications, […]
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AI Reduces Surprise Bills

Enhancing Payment Integrity With AI To Eliminate Surprise Bills

It’s common for people to feel surprised by the cost of hospital, medical imaging, or outpatient surgery bills. Unfortunately, it’s difficult for them to verify whether the bill is accurate or not. This is because incorrect medical bills have become increasingly common. To address this issue, organizations are turning to technologies such as artificial intelligence […]
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Coding Requirement Reduced EHR Burden

New Coding Requirements Result in Reduced EHR Documentation Time for Doctors

According to a research letter published in top journal, the attempt by Centers for Medicare & Medicaid Services (CMS) to alleviate the EHR documentation burden on physicians has not yielded the anticipated outcomes. At the beginning of 2021, Centers for Medicare & Medicaid Services (CMS) revised the evaluation and management (E/M) coding requirements for outpatient […]
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Benefits of Automated Medical Coding

How Automated Medical Coding Benefits Healthcare Sectors?

The relationship between medical coding and patient care may not initially appear connected, and they may even seem like complete opposites. While medical coding focuses on billing and revenue, patient care revolves around providing care to individuals. An from leading E-magazine’s recent article  emphasized this distinction, asserting that prioritizing care is essential over coding. However, […]
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Role of Data Analytics in Healthcare

Advantages of Data Analytics in Healthcare: Patient Outcomes, Efficiency, Precision

 With the healthcare sector generating vast volumes of data, leveraging data analytics can lead to improved patient outcomes, reduced costs, and enhanced operational efficiencies for Advantages of Data Analytics in Healthcare. Data analytics encompasses the collection, management, and analysis of extensive data to identify patterns, insights, and trends, enabling more informed decision-making. In the healthcare […]
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Medicare Advantage Insurers

Senators seek accountability from Medicare Advantage insurers on claims denials

In Congress this week, it wasn’t just pharmacy benefit managers facing scrutiny. The Senate’s Permanent Subcommittee on Investigations directed its attention towards Medicare Advantage (MA) plans, seeking explanations for claims denials. During the hearing, the committee’s chairman highlighted that letters were sent to the three largest MA plans—UnitedHealthcare, Humana, and Aetna—requesting documentation regarding their decision-making […]
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