The healthcare industry has long buzzed about the potential of Artificial Intelligence (AI) to revolutionize financial operations and internal workflows. However, for practical solutions tackling the complexities of RCM, intelligent automation offers a more realistic path forward. Why Intelligent Automation Over AI? True AI strives to mimic human cognition, but it remains in its early […]
Ideally, revenue cycle processes should flow seamlessly from one stage to the next. However, challenges can arise at any point, from the front end to the back end, requiring leaders to be vigilant and strategic in their efforts. Here are some highlighting executive approaches to various revenue cycle challenges: How Healthcare Services Revamped Their Billing […]
When your medical practice submits a claim to a payer, the countdown begins until you receive the payment. Ensuring timely payment is crucial for your business, as delays can have costly consequences. Ideally, you should aim to clear accounts receivable within 30 days. To effectively reduce accounts receivable, it’s essential to implement efficient billing processes, […]
The world of medical billing and accounts receivable (AR) can feel like a labyrinth for healthcare providers. Lost in a maze of codes, claims, and denials, it’s easy to see revenue slip through the cracks. But fear not! Here’s our guide to mastering AR and ensuring your practice thrives. Medical Billing & Accounts Receivable Medical […]
Here are some steps to guide you through the process of appealing a denied health insurance claim: 1. Understand the Reason for Denial Review the Denial Letter: Carefully read the denial letter from your insurance company. It should explain why your claim was denied and how you can appeal the decision. Check you’re Policy: Refer […]
In 2024, factors like declining reimbursement rates, the shift towards value-based care, and ever-changing regulations demand a proactive approach to improve RCM. Here, we explore four key strategies to optimize your healthcare revenue cycle and ensure financial stability in the coming year. 1. Break down Silos: Merging Front-End and Back-End Functions Many healthcare organizations struggle […]
The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
It is important to note that the Health Insurance Portability and Accountability Act (HIPAA) Security Rule of 1996 established standards for protecting individuals’ electronic personal health information (PHI). This includes any identifiable health information, such as medical records and histories, medical bills, and lab results, among others. A covered entity, including healthcare providers, health plans, […]
Claims Denial: Healthcare Leaders report an increase in payer denials, putting increasing pressure on the system’s finances. Going back and forth with denied payers is a long and expensive process, and low reimbursement rates don’t help either. In a new survey conducted by the Healthcare Financial Management Association, CFOs noted a significant increase in denials, […]
Providers who spend too much on RCM staff and processes, or who experience a high rate of claims denials, should consider outsourcing their medical billing requirements. While our experts chase down payments, you can provide the care, receive the funds, and improve your key performance indicators. Outsource RCM makes sense Why Healthcare Providers Are Turning […]