Tag: Healthcare Compliance

Clinical validation Queries

Enhancing Clinical Validation Queries to Address Rising Denials

The volume of clinical validation denials is increasing, yet clinical validation queries have not kept pace. One key reason for this discrepancy is the complexity involved in constructing clinical validation queries, which require precise and thorough documentation to ensure accurate coding and reimbursement The Unique Challenges of Clinical Validation Queries Unlike traditional queries that request […]
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Medical-Billing-Innovations_-What-2024-Taught-Us-and-Whats-Next

Medical Billing Innovations: What 2024 Taught Us and What’s Next

As 2024 draws to a close, the healthcare industry reflects on a year of groundbreaking innovations, policy shifts, and evolving challenges in medical billing. The Allzone Management Services team has seen first-hand how these changes have improved revenue cycle management (RCM), streamlined processes, and patient satisfaction as a result of these changes. In this newsletter, […]
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Automated Insurance Eligibility Checks: Improving AR Days

Automated Insurance Eligibility Checks: Improving AR Days

Table of Contents Understanding the Impact of Denials and AR Days The Role of Automated Insurance Eligibility Checks Benefits of Automated Insurance Eligibility Checks Implementing Automated Insurance Eligibility Checks Insurance Eligibility Verification Service: A Critical Step for Healthcare Practices One significant challenge that healthcare providers face is the high rate of insurance claim denials and […]
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Mastering Historical Medical Code Sets for Audits, Appeals, and Research

Mastering Historical Medical Code Sets for Audits, Appeals, and Research

Remaining up-to-date is essential in the healthcare industry, but relying solely on current codes isn’t always the best approach. When auditing, handling appeals, or researching code usage for past encounters, a solid grasp of the descriptors and guidelines applicable during the date of service (DOS) can profoundly impact outcomes. Here’s a concise guide on effectively […]
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ICD-10-CM code updates

ICD-10-CM Updates: What You Need to Know

The accuracy of medical coding in the ever-evolving healthcare industry is not only crucial for accurate billing, but it is also crucial for quality reporting, compliance, and patient outcomes. The ICD-10-CM codes for 2024 have been updated, resulting in new and revised codes for healthcare providers that have an impact on multiple aspects of patient […]
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Optimizing Debridement Coding: Tips for Accurate Claims and Payments

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
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Growth in the Medical Billing Industry: Trends and Challenges

Growth in the Medical Billing Industry: Trends and Challenges

The medical billing industry, while complex and often mired in regulatory hurdles, is experiencing a period of growth and transformation. A recent survey conducted by healthcare software company, a digital health operating system company, revealed that 65% of medical billing companies hold a positive outlook on the industry’s future. This optimism is fueled by several […]
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Benefits of Outsourcing rcm

The benefits of outsourcing RCM functions

Here’s a rewritten version of the provided text, aiming for a more concise and impactful delivery: Navigating the complexities of today’s healthcare revenue cycle management (RCM) presents a significant challenge for providers. A key advantage of Revenue Cycle Management outsourcing lies in its ability to alleviate these substantial administrative burdens, which often escalate with evolving […]
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ICD-10 to ICD-11: Bridging the Gap with Best Practices

The Evolution of Medical Coding (ICD-10 to ICD-11) As we transition from ICD-10 to ICD-11, it’s crucial to understand the implications of these changes on data accuracy, clinical documentation, and overall healthcare management. Healthcare data are based on medical coding, which plays a vital role in categorizing diseases, health conditions, and medical procedures. It has […]
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Demystifying the Most Common ICD-10 Coding Challenges

Demystifying the Most Common ICD-10 Coding Challenges

Medical coding is the backbone of administrative and clinical processes in healthcare. This landscape is characterized by the International Classification of Diseases, 10th Edition (ICD-10), which provides a standardized system to classify diseases, injuries, and medical procedures. While ICD-10 offers robust benefits in terms of specificity and data granularity, healthcare professional’s worldwide face significant challenges […]
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