Category: Blog

Medicare Overpayment Rule

Navigating the 2025 Medicare Overpayment Rule Changes

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule significantly changing how healthcare providers must handle Medicare overpayments. The new Medicare Overpayment Rule, effective January 1, 2025, is part of the 2025 Physician Fee Schedule Final Rule and impacts Medicare Parts A/B (Traditional Medicare) and C/D (Medicare Advantage and Prescription Drug Plans). […]
Learn More
RCM automation

Maximizing A/R Efficiency with RCM Automation

A well-managed A/R process ensures timely cash flow, reduces administrative burdens, and maintains the stability of a healthcare practice. However, many healthcare practices still struggle with outdated, manual A/R management processes that can lead to inefficiencies, errors, and delayed payments. In recent years, Revenue Cycle Management (RCM) automation has emerged as a game-changer in addressing […]
Learn More
Denial Management Process

3 Proactive Strategies for Improving Denial Management

In the ever-evolving field of medical billing, denied claims remain a significant obstacle for healthcare providers. Studies reveal that over 10% of claims face initial rejection by insurers, leading to revenue losses, administrative strain, and frustration for all stakeholders. To mitigate these challenges and ensure financial stability, an effective denial management process is essential. However, […]
Learn More
Medicare physician participation

Medicare Physician Participation Trends and Payment Challenges

Medicare provides health insurance coverage to 67 million individuals, accounting for 20% of the U.S. population, and serves as a vital revenue source for healthcare providers. Medicare Part B expenditures—encompassing physician services, outpatient care, and physician-administered drugs—constituted nearly 49% of Medicare’s total benefit spending. Although Medicare physician participation is optional, the vast majority of healthcare […]
Learn More
telehealth billing strategies

Telehealth Billing Strategies: Maximizing Revenue

Telehealth revenue can be a lifeline for many healthcare organizations struggling financially due to cancellations of elective and non-urgent procedures. However, maximizing this revenue stream requires effective Telehealth Billing Strategies. This includes accurate coding, timely claim submissions, and navigating the complexities of payer reimbursement policies for virtual services. Understanding Telehealth Billing: A Few Key Concepts […]
Learn More
Medicare telehealth policies

Telehealth Policies in 2025: Key Medicare Updates and What’s Next

The American Relief Act of 2025 has brought critical updates to Medicare telehealth policies, reinforcing telemedicine as a viable healthcare solution. With the dust now settled, let’s revisit the changes to Medicare telehealth policies and examine what lies ahead. Key Telehealth Policies Extended Through 2025 The Centers for Medicare & Medicaid Services (CMS) has maintained […]
Learn More
CAR-T therapy coding

A Deep Dive into CAR-T Therapy Coding and Billing for Medicare

Stay updated with the latest guidelines for reporting products and procedures related to Chimeric Antigen Receptor (CAR) T-cell therapy to ensure accurate CAR-T therapy coding and billing for Medicare patients. Overview of CAR-T Therapy CAR-T is a cutting-edge cell-based gene therapy that modifies a patient’s own T lymphocytes (T-cells) in a lab to express chimeric […]
Learn More
AI in Revenue Cycle Management

How AI is Revolutionizing Revenue Cycle Management

However, AI in Revenue Cycle Management is emerging as a transformative solution. By automating repetitive tasks, improving accuracy, and providing actionable insights, AI is helping healthcare organizations streamline their processes and tackle these challenges more effectively. Revenue Cycle Management (RCM) is a cornerstone of healthcare operations, yet the growing complexity of today’s healthcare landscape poses […]
Learn More
Ophthalmology Billing

Navigating Ophthalmology Billing: Challenges & Best Practices

Ophthalmology, as a specialized field within healthcare, presents unique challenges when it comes to Ophthalmology Billing. From the intricate nature of eye-related procedures to various coding requirements, Ophthalmology Billing is a nuanced process that requires precision and understanding. Healthcare providers in this specialty must navigate complex coding systems, insurance policies, and regulatory requirements to ensure […]
Learn More
Prior Authorization reforms

CMS Prior Authorization Reforms: A Step Forward, But More Needed

The updated CMS regulations on prior authorization have been lauded as a significant step toward reducing administrative burdens for physicians. However, critics argue that the changes fall short of addressing the broader issues. Accelerating Prior Authorization and Enhancing Transparency Issued in January, these regulations mandate federally regulated health plans to enhance electronic health information exchange […]
Learn More
x