Category: Medical Billing

How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

How to Fight Surprise Medical Bills and Coverage Denials: A Proven Strategy

Have you recently received a surprising medical bill or had your insurance coverage denials for a recommended treatment? Unfortunately, you’re not alone. A recent national survey by the Commonwealth Fund, a leading healthcare research organization, found that a significant number of insured Americans face these challenges. While many may choose not to contest these issues, […]
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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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Key steps for successful Medical Billing Process

Key steps for successful Medical Billing Process

The medical billing process is a complex system that requires various steps to ensure accuracy and efficiency. Medical billing services work hard to make sure that medical bills are processed quickly and accurately, allowing for timely payments from insurance companies. 1. Patient Registration The medical billing process begins with patient registration, where the patient’s demographic […]
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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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