Tag: healthcare payers

Medical coding Audits

Medical Coding Audits: Trends and Guide for Providers

The landscape of medical coding audits is constantly evolving.  Staying informed about these trends and implementing best practices can significantly reduce stress and ensure a smooth audit experience. The Shifting Landscape of Medical Coding Audits Traditionally, medical coding audits felt like a lottery. Providers faced the uncertainty of random reviews, often scrambling to address issues […]
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CPT Modifier

Six Tips to Getting Paid for CPT Modifiers

In medical coding, CPT modifier are vital for accurate reimbursement of healthcare services. These special codes, attached to primary procedure codes, provide additional details about the complexity or extent of a service. However, using modifiers incorrectly can lead to claim denials and lost revenue. This blog post shares six key tips to help you get […]
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Tips-To-Maximize-Medical-Billing-and-Coding-Efficiency

Tips To Maximize Medical Billing and Coding Efficiency

Ensuring precise claims processing and prompt reimbursements, healthcare practitioners rely heavily on efficient medical billing and coding procedures. The act of streamlining these functions holds the potential to not only heighten overall effectiveness but also to curtail administrative burdens and mitigate the risk of errors. Within this article, we will delve into a selection of […]
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Benefits of Advanced Healthcare Technology

Benefits of Advanced Healthcare Technology for Providers & Payers

Collaboration among a diverse team that blends clinical expertise and technical proficiency is essential in today’s dynamic healthcare environment to overcome administrative and diagnostic challenges. This multidisciplinary approach facilitates the creation of healthcare technology solutions that benefit all stakeholders, including payers, providers, and patients. By adopting a more personalized approach, treatment outcomes can be optimized […]
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Automating Claim Processing

Automating Claims Processing in the Healthcare Industry

By utilizing automation, it is feasible to improve the upstream and downstream adjudication process through data validation and routing. The healthcare industry can benefit from automation in almost all administrative functions, but it can significantly improve the auto-adjudication rate. In an ever-changing industry, possessing technical expertise is of utmost importance. The healthcare sector is increasingly […]
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The-State-of-Claims-and-Denials-in-2023

The State of Claims and Denials in 2023

How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]
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Key-Benefits-of-Using-Total-Practice-Management-System

Key Benefits of Using Total Practice Management System

Providers draw more on-time and uncut payer reimbursements and patient payments by automating these operations with a quality practice management system Via using a quality total practice management system, your company can evade putting as much attempts into accomplishing quality work and rather find effectiveness, accuracy, and peace of mind. An integrated billing and scheduling […]
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Hospitals-Comply-with-the-Price-Transparency-Rule

Only a Few Hospitals Comply with the Price Transparency Rule

Over 1,500 hospitals reviewed in the report were noncompliant with at least one requirement of the price transparency rule between December 2022 and January 2023. Less than a quarter of hospitals are complying with the hospital price transparency rule over two years after the regulation went into effect, according to a report from PatientRightsAdvocate.org. The […]
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Medicaid-Expansion-Boosts-Financial-Performance-of-Providers

Medicaid Expansion Boosts Financial Performance of Providers

Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial performance and resulting in payer mix improvements, data from the Kaiser Family Foundation (KFF) found. All but 11 states have expanded Medicaid eligibility as of January […]
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