Managing denied claims remains one of the most challenging challenges for healthcare providers and Revenue Cycle Management (RCM) professionals as healthcare reimbursement models continue to evolve. As well as delaying payments, claim denials contribute to administrative burdens, reduced cash flow, and significant revenue losses. Medicare denial rates are approximately 10%, according to the American Medical […]
The healthcare industry has traditionally been a black box when it comes to pricing. Patients, providers, and payers alike have often struggled to understand the complex web of costs associated with medical services. However, a seismic shift is underway. The advent of price transparency regulations and the evolving role of Revenue Cycle Management (RCM) are […]
The healthcare industry has long buzzed about the potential of Artificial Intelligence (AI) to revolutionize financial operations and internal workflows. However, for practical solutions tackling the complexities of RCM, intelligent automation offers a more realistic path forward. Why Intelligent Automation Over AI? True AI strives to mimic human cognition, but it remains in its early […]
When your medical practice submits a claim to a payer, the countdown begins until you receive the payment. Ensuring timely payment is crucial for your business, as delays can have costly consequences. Ideally, you should aim to clear accounts receivable within 30 days. To effectively reduce accounts receivable, it’s essential to implement efficient billing processes, […]
The US health care system, one of the best in the world, with qualified doctors trained in world medical schools, faces a major flaw: reduce medical errors, which cause about 1 in 1 10 Americans died and cost the country $20 billion age. Almost 2 out of 3 of these errors are based on poor […]
In 2024, factors like declining reimbursement rates, the shift towards value-based care, and ever-changing regulations demand a proactive approach to improve RCM. Here, we explore four key strategies to optimize your healthcare revenue cycle and ensure financial stability in the coming year. 1. Break down Silos: Merging Front-End and Back-End Functions Many healthcare organizations struggle […]
The healthcare industry holds hidden potential for improved revenue and streamlined operations. Charge capture audits act as your key to unlock these hidden treasures. Similar to explorers seeking buried riches, healthcare organizations can embark on a quest for financial stability through these audits. This guide will explain charge capture audits, help you identify hidden opportunities, […]
RCM optimization: While maximizing revenue is paramount in today’s competitive business environment, many organizations experience inefficiencies in their RCM processes. Here’s where data becomes your secret weapon. With data-driven strategies, you can maximize your revenue cycle management (RCM), unlock revenue potential, and grow significantly. Understanding RCM and its Impact on Revenue In Revenue Cycle Management […]
The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
Chiropractic billing tips: Running a successful chiropractic center involves more than just delivering exceptional patient care. A critical yet often overlooked aspect is ensuring a smooth and efficient billing process. With a constant flow of patients, managing insurance complexities and ever-changing regulations can quickly become overwhelming. 8 key chiropractic billing tips to keep your Revenue […]