In today’s highly regulated healthcare environment, CPT and ICD code compliance isn’t just about accuracy—it’s about protecting your revenue, safeguarding against penalties, and ensuring smooth reimbursements. Healthcare providers and billing teams face increasing pressure to align with payer rules, CMS guidelines, and continuous code updates. A single coding error can result in denied claims, delayed […]
Introduction In medical billing, claim rejections and denials are inevitable—but understanding why they occur is the key to fixing them. One of the most important tools for decoding these denials is the Claim Adjustment Reason Code (CARC). Each CARC provides specific information about why a claim or a service line was adjusted, denied, or paid […]
A stroke, or cerebrovascular accident (CVA), occurs when the brain’s blood supply is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Accurate medical coding for stroke is essential to ensure proper documentation, reimbursement, and statistical tracking of healthcare outcomes. In the healthcare revenue cycle, accurate ICD-10 coding not only impacts claim success but […]
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 […]
When it comes to the Merit-based Incentive Payment System (MIPS), 2025 data reveals a striking disparity: small and rural medical practices were disproportionately penalized, facing significantly higher penalties than their larger, urban counterparts. While the vast majority of MIPS-eligible clinicians (86%) successfully avoided penalties this year, based on their 2023 data, those who did incur […]
In the complex world of insurance and healthcare claims, the concept of “zero-paid claims” can feel like a phantom menace. You’ve submitted a claim, received an Explanation of Benefits (EOB) or remittance advice, and to your dismay, the payment is… zero. While a zero payment might seem innocuous, it can, in certain scenarios, be interpreted […]
Outpatient care has become a cornerstone of modern healthcare, thanks to technological advancements, patient preferences, and cost-effective treatment models. As outpatient services expand, so do the administrative and financial complexities behind the scenes. Revenue Cycle Management (RCM) for outpatient care is no small feat — it involves managing patient scheduling, insurance verification, coding, billing, and […]
In today’s competitive healthcare environment, delivering an exceptional ASC patient experience is crucial for differentiating your ambulatory surgery center (ASC) and fostering sustainable growth. This experience hinges on treating patients with care, respect, and competence throughout every interaction – from staff engagement to procedural efficiency and technological integration. This article focuses specifically on enhancing the […]
In today’s evolving healthcare landscape, financial stability is a growing concern for healthcare providers. With rising administrative costs, increasing payer scrutiny, and complex reimbursement policies, managing medical billing in-house is becoming increasingly challenging. As we approach 2025, the demand for faster, more efficient payments is greater than ever, driving many healthcare providers to explore outsourcing […]
Revenue cycle management (RCM) is the lifeblood of any healthcare organization. However, even with the most diligent efforts, denials are an inevitable part of the process. These denials, if not addressed efficiently, can significantly impact your cash flow and overall financial health. That’s where streamlining your medical denials process becomes crucial. In this blog, we’ll […]