Tag: Healthcare billing

Compliance in medical coding

Navigating Regulatory Compliance in Medical Coding for Accurate Billing

Explore the intricacies of codes for a better understanding of regulatory compliance in medical coding. Healthcare billing and documentation are based on medical coding. An accurate representation of the patient’s health journey, appropriate reimbursements, and avoiding potential legal pitfalls are crucial to ensuring accurate representation of the patient’s health journey, not just an administrative formality. […]
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Preventive-Visits-VS-Office-Visits

Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
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Top-3-Revenue-Cycle-Hurdles

Top 3 Critical Challenges for Revenue Cycle Leaders in 2024

 As we approach the end of 2023 and the holiday season draws near, revenue cycle leaders ought to contemplate including these three challenges in their organization’s roster of New Year’s resolutions. Automating Payer Processes: Similar to healthcare organizations, payers have also started embracing automated solutions, intensifying challenges in managing denials and causing delays in payment […]
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ICD-10 Audits: Keeping Your Reimbursements Safe with Precision Coding

ICD-10 audits. Just the mention sends shivers down the spines of healthcare providers everywhere. These meticulous examinations hold the power to either boost your bottom line or leave you facing a financial black hole. But fear not! By embracing precision coding, you can transform audits from dreaded foes into powerful allies that protect your reimbursements […]
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8-Powerful-Strategies-to-minimize-Denied-Claims

8 Successful Tactics for Reducing Denied Claims 2024

Roughly 65% of rejected claims aren’t reprocessed for resubmission (Zindl, 2021). As one of the healthcare industry’s numerous challenges, the upward trend of denied claims persists, with many left unaddressed. This has repercussions for both providers and patients alike. When denied claims remain unsubmitted, providers face substantial losses. Beyond revenue, these rejections strain staffing resources. […]
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3-Key-Strategies-for-Revenue-Cycle-Leadership-for-Operational-Success-in-2023

3 Key Strategies for Revenue Cycle Leadership for Operational Success in 2023

To ensure both financial stability and operational efficiency, revenue cycle leaders must reinforce three essential areas. The challenges of grappling with low operating margins, diminished reimbursements, and escalating costs will persist throughout 2024. In an era where a subpar financial journey could overshadow a top-tier clinical experience for patients, the burden on revenue cycle leaders […]
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Medical Coding Strategies to Prevent Payer Denials

As a former emergency department physician from the U.K., this individual was well aware of claim denials and rejections, with payers frequently withholding or reducing payments. However, it was only when his personal insurance company, denied his medical claim for a vitamin D test that he decided to delve deeper into the issue. He found […]
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Revenue Cycle Billing Challenges

Revenue Cycle Billing Challenges: Insights from Patient Experience

To enhance the financial experience of patients, it is crucial to closely examine an organization’s billing procedure. HealthLeaders is joining the celebration of Patient Experience Week from April 23-29 by highlighting the efforts of revenue cycle leaders in establishing a favorable financial experience for patients in their organizations. With a suboptimal financial experience capable of […]
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CMS pitches inpatient payment rule for 2023: 10 things to know

CMS released its annual Inpatient Prospective Payment System proposed rule April 18, which proposes a reimbursement boost for acute care hospitals. Here are 10 things to know about the 1,786-page proposed rule: Payment rate update. Under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs will see a […]
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