Category: Blog

AI in Healthcare: Revealing the Risks and Challenges Ahead

AI in Healthcare: Revealing the Risks and Challenges Ahead

AI represents a promising frontier, especially in healthcare, where leveraging vast information could revolutionize problem-solving. However, a shadow looms over AI, as anticipated by many. In the realm of health insurance and patient care denials, AI has already stirred controversy, leading to a notable class action lawsuit. According to reports from healthcare News, Health Insurance […]
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Clinicians Struggle with Medical Coding Amid Patient Care Responsibilities

Clinicians Struggle with Medical Coding Amid Patient Care Responsibilities

Presently, healthcare professionals face growing administrative demands alongside their patient-focused duties. A pivotal challenge among these is medical coding, essential for various reasons. It ensures adherence to billing standards impacting reimbursements, meets quality metrics established by healthcare entities and insurers, and guarantees precision in diagnoses recorded for billing purposes. Yet, the task of accurate coding […]
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Medicare Advantage Value-Based Care: Enhanced Health Outcomes

Medicare Advantage Value-Based Care: Enhanced Health Outcomes

Alongside its positive impact on health outcomes, the Medicare Advantage value-based care plans implemented by an insurance provider resulted in a significant $8 billion in cost savings throughout 2022. Reports from the payer revealed that Medicare Advantage beneficiaries under value-based care exhibited improved health conditions, marked by reduced inpatient admissions and emergency room visits. The […]
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The Rise of Hybrid Global Outsourcing Models in Healthcare

The Rise of Hybrid Global Outsourcing Models in Healthcare

Given labor shortages and financial constraints, fully managed hybrid outsourcing solutions are increasingly gaining prominence. Hospitals and provider organizations grapple with staffing deficiencies across various departments, with the revenue cycle facing considerable strain. A recent survey among medical group leaders highlighted coders as the most challenging role to fill, closely followed by billers, schedulers, authorization […]
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Understanding ABNs for Providers and Medicare Beneficiaries

Understanding ABNs for Providers and Medicare Beneficiaries

The Advance Beneficiary Notice (ABN), Form CMS-R-131, issued by the Centers for Medicare & Medicaid Services (CMS), holds immense importance for healthcare providers, revenue cycle teams, and Medicare beneficiaries. What is an ABN (Advance Beneficiary Notice)? An ABN, formally extended to Medicare Fee-for-Service (FFS) beneficiaries, precedes outpatient services like labs, imaging, physical therapy, or observation. […]
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Anticipated Decrease in Medicare Reimbursement for Physicians in 2024

Anticipated Decrease in Medicare Reimbursement for Physicians in 2024

The Final Decrease Is Influenced By Add-On Codes and Regulatory Obligations On November 16th, the Centers for Medicare & Medicaid Services (CMS) released the finalized rule for the 2024 Medicare Physician Fee Schedule (MPFS) in the Federal Register. While the policies exhibit several positives, especially in primary care, telehealth, and behavioral healthcare, CMS remains dedicated […]
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Top 10 Healthcare Technology Trends 2024: AI, Virtual Care, and More

Healthcare is facing an escalating crisis due to workforce shortages, expected to persist into 2024. This situation has compelled healthcare organizations to operate with constrained resources while grappling with financial strain. Concurrently, healthcare leaders acknowledge the imperative of tackling widening health inequalities and environmental issues to ensure the sustainability and inclusivity of healthcare systems. The […]
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Unveiling the Top 5 Healthcare Revenue Cycle KPIs

Unveiling the Top 5 Healthcare Revenue Cycle KPIs

Key Performance Indicators (KPIs) within the healthcare revenue cycle play a vital role in monitoring financial well-being and optimizing revenue capture for providers. Understanding these metrics is crucial for healthcare organizations aiming to sustain access to high-quality, cost-effective care—an essential aspect of the evolving landscape of value-based care and healthcare consumerism. These KPIs offer critical […]
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Health care bill with a wide range of provisions would impact physicians

Health care bill with a wide range of provisions would impact physicians

The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
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