Tag: Revenue Cycle Management

RCM KPIs

Top 5 KPIs Every RCM Leader Should Track This Year

In today’s complex healthcare environment, revenue cycle management (RCM) has become more critical than ever. As patient expectations evolve and regulatory requirements grow more stringent, the pressure on RCM leaders to ensure financial sustainability while maintaining high-quality patient care is immense. With tight margins and rising operational costs, understanding and optimizing the right RCM KPIs […]
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Medicare Advantage plans benefit

Medicare Advantage Plans Benefit from Expert Medical Billing

As the U.S. healthcare system continues to evolve, Medicare Advantage (MA) plans have seen rapid growth, offering seniors an alternative to traditional Medicare. With more than 30 million beneficiaries enrolled in Medicare Advantage as of 2025, the demand for administrative efficiency and accurate claims processing has never been greater. Medical billing companies play a pivotal […]
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Electronic Prior Authorization

Electronic Prior Authorization: Improving Speed and Efficiency for Physicians

In the intricate dance of healthcare administration, few processes have historically caused as much friction as prior authorization. The traditional, often manual, methods of obtaining approval for medical services and medications have long been a source of frustration for both physicians and patients. Lengthy wait times, administrative burdens, and potential delays in necessary care have […]
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Prior Authorization Burden

9 Ways to Ease the Prior Authorization Burden and Reclaim Your Time

Prior authorization (PA) is a necessary but often frustrating part of the healthcare reimbursement process, and the prior authorization burden it creates is substantial. While insurers use it to manage costs and ensure medical necessity, the administrative burden it places on physicians, billing staff, and patients is immense. A 2022 American Medical Association (AMA) survey […]
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Prior Authorization Automation

Unlock Revenue Growth and Slash Denials with Prior Authorization Automation

In the intricate dance of healthcare administration, prior authorization often feels like an unwelcome and time-consuming interruption. The manual processes involved – phone calls, faxes, and endless paperwork – not only burden staff but also create significant bottlenecks that can lead to delayed patient care, increased operational costs, and, critically, a higher rate of claim […]
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Telehealth RCM Optimization Tips

Optimize Telehealth RCM: Tips for Financial Success

The rise of telehealth has revolutionized healthcare delivery, offering convenience and accessibility for patients and providers. However, this shift brings its own set of challenges, particularly when it comes to Revenue Cycle Management (RCM). Addressing these challenges effectively through Telehealth RCM Optimization Tips is crucial for ensuring financial health, minimizing claim denials, and maximizing revenue […]
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Outpatient Medical Billing Process

8 Steps to Clean Up Your Outpatient Medical Billing Process

Is your outpatient medical billing process feeling more like a tangled web than a well-oiled machine? You’re not alone. In the fast-paced world of healthcare, billing errors and inefficiencies can easily creep in, leading to delayed payments, increased denials, and a significant drain on your practice’s resources. The good news? You don’t have to overhaul […]
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Reproductive Healthcare Data Privacy

Understanding the HIPAA Reproductive Healthcare Data Privacy Final Rule

The final rule issued by the Biden administration aimed to bolster the privacy of reproductive healthcare data under HIPAA, a significant move following the Supreme Court’s overturning. Health and Human Services (HHS) officials hoped this rule would alleviate the “chilling effect” on individuals seeking or providing legal reproductive healthcare, stemming from both legal challenges and […]
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Hospital Claim Validation

Hospital Claim Validation: A Proactive Strategy to Prevent Denials

Claim denials cast a long shadow over hospital finances, eroding revenue cycles, inflating administrative burdens, and ultimately jeopardizing the institution’s financial stability. While some denials are unavoidable, a powerful and forward-thinking Hospital Claim Validation strategy can dramatically reduce their frequency.  This approach emphasizes embedding accuracy and compliance at every touchpoint of the patient journey and […]
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E/M coding tips

Top E/M Code Tips to Boost Revenue and Mitigate Compliance Risk

This post dives into the top E/M coding tips that will empower your team to accurately capture the level of service provided, optimize revenue, and navigate the intricate landscape of compliance with confidence. 1. Embrace the 2021/2023 E/M Guidelines for Office/Outpatient Visits (99202-99215): The significant changes introduced in 2021 and further refined in 2023 for […]
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