The healthcare industry is in constant flux, and staying abreast of the latest Medicare billing rule updates is paramount for healthcare providers. As we navigate 2025, several significant changes have come into effect, impacting reimbursement, telehealth services, care delivery models, and compliance requirements. This blog post aims to provide a comprehensive overview of these updates […]
Claim denials remain one of the biggest challenges healthcare providers face when it comes to maintaining consistent revenue and smooth operations. While some common causes like incomplete documentation and incorrect patient information are well-known, there are still many lesser-known or overlooked reasons medical claims get denied. In this article, we’ll explore five more reasons why […]
In healthcare, claim denials pose a significant challenge to a provider’s revenue cycle. Each year, over $4.5 trillion in claims are submitted to insurance carriers in the U.S. alone. Despite this volume, healthcare providers continue to see an alarming rise in denied claims. In 2022, 42% of respondents reported an increase in denials, but by […]
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 […]
It is expected that the Centers for Medicare & Medicaid Services (CMS) will release a completely revamped version of the evaluation and management (E&M) codes by 2021, particularly for the office visit codes (999201-99205 and 99211-99215). In addition to the changes to the office visit codes, there were significant changes to the 2023 guidelines. These […]
Claim scrubbing enables the potential for increased accuracy in claims, enhanced client relationships, and improved patient interactions. Claim scrubbing is the process of identifying and rectifying coding errors in medical claims prior to their submission to insurance providers. Whether conducted manually or through automated systems, claim scrubbers validate medical claims before they are sent to […]
It’s common for people to feel surprised by the cost of hospital, medical imaging, or outpatient surgery bills. Unfortunately, it’s difficult for them to verify whether the bill is accurate or not. This is because incorrect medical bills have become increasingly common. To address this issue, organizations are turning to technologies such as artificial intelligence […]
The 2023 CPT code set will update the rest of the E/M code section after significant changes in 2021, as well as revise AI and virtual care codes. The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for […]
Changes to ICD-10-CM Diagnosis Code mean NCD coding changes. ICD-10-CM Diagnosis Code changes went into effect Oct. 1, as usual, and the Centers for Medicare & Medicaid Services (CMS) is updating National Coverage Determinations (NCDs) to reflect those changes. NCDs Affected by Updates to ICD-10-CM Diagnosis Code CMS notes the following NCD coding changes in […]
Ending surprise medical bills has risen to a national priority with bipartisan political interest. In January, President Donald Trump directed Cabinet officials to find a solution, and multiple congressional bills were proposed in the last Congress with the same goal. Surprise medical bills consist of unanticipated charges from out-of-network clinicians—often when the facility or primary physician is […]










