Getting an appeal denied insurance claim can feel like hitting a brick wall, but it doesn’t mean your fight for coverage is over. Many denied claims are overturned on appeal. By understanding the process and being persistent, you can significantly increase your chances of getting the benefits you deserve. This comprehensive guide will walk you […]
The U.S. healthcare industry continues its digital transformation, with providers and payers embracing electronic transactions to streamline revenue cycle management (RCM) processes. According to the CAQH Index, adoption of electronic claims management transactions—such as eligibility verification, claim submissions, and claim status inquiries—has reached or surpassed 80% for many transaction types. However, significant gaps remain in […]
In today’s evolving healthcare environment, medical billing compliance is more than just a legal requirement—it’s a strategic safeguard for your medical practice. As regulations tighten and audits become more frequent, staying compliant with medical billing standards helps protect your practice from costly fines, revenue losses, and reputational damage. What Is Medical Billing Compliance? Medical billing […]
Turning submitted medical claims into actual payments is a crucial phase for any healthcare practice. The time it takes to receive these payments directly impacts your financial health and operational efficiency. To maintain a healthy revenue cycle, it’s essential to reduce AR turnaround time and aim to clear your Accounts Receivable (AR) within a 30-day […]
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 […]
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), […]
In the ever-evolving world of healthcare, revenue cycle management (RCM) plays a crucial role in the success of any medical practice. Efficient RCM ensures timely and accurate payment for services rendered, which can significantly impact the financial health of a practice. 13 Essential Steps for Effective Revenue Cycle Management in Practice 2024 1. Verify Patient […]
Discover how healthcare providers can accelerate cash flow, minimize denials, reduce operational costs, and enhance patient satisfaction through streamlined Revenue Cycle Management (RCM). RCM is a strategic approach to overseeing all financial aspects of a patient’s journey, from initial appointment scheduling to final bill payment. This article highlights the critical role RCM plays in maximizing […]
Don’t allow preventable error to disrupt your revenue cycle. In order for a claim to be considered clean, it must contain all necessary information for the payer to fully process it without requiring further investigation or development. This includes being submitted within the designated timeframe, passing all necessary reviews, having any required medical evidence or […]
CMS is reminding organizations of Medicare Secondary Payer (MSP) billing and appeal processes after the agency inappropriately denied some claims. Organizations are advised that they must continue to provide services to patients who have open or closed secondary payer records on file or if Medicare inappropriately denied a claim, according to MLN Matters SE21002. Organizations are […]