Don’t limit your potential by ignoring claim denials. Did you know that over 86% of denials are easily avoidable? Each denied claim represents a missed opportunity. While this may seem like a minor setback at first, it can quickly lead to significant losses. Unresolved claims can cost healthcare practices up to 5% of their net […]
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According to the U.S. Centers for Medicare & Medicaid Services, private and government health insurance payers process over 5 billion medical claims annually. A complaint submitted to the U.S. Department of Justice stated that nearly 95% of these medical claims are transferred electronically via EDI clearinghouses. Since the rise of electronic medical claim filing, clearinghouses
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Coding and its technologies have significantly evolved with time. While these continuous advancements improve the healthcare system in several ways, they also create problems for coders, especially those just starting their careers. As a result, many new coders face productivity issues. This is a major concern because coding productivity is directly linked with billing efficiency.
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Without vendors, hospitals and small healthcare centers will not have the equipment, supplies, and technology needed to deliver patient care. In the vast and intricate healthcare system, vendors are individuals or entities that provide goods and services to medical facilities, ensuring their proper functioning. However, before a payment contract is signed between the hospital and
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Around 14% of patients discharged from hospitals are readmitted within 30 days, and it costs U.S. taxpayers more than $52.4 billion per year to care for the readmitted patients. The U.S. Centers for Medicare and Medicaid Service (CMS) has implemented several programs to reduce the readmission rate of Medicare beneficiaries. Transitional Care Management (TCM) is
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Have you ever wondered how other practices achieved their current revenue growth? Well, they all have one thing in common – an efficient billing process. As the fourth most populated state in the country, New York has over 261 active hospitals. However, complex insurance regulations, high workload, increased scrutiny from payers, and, most importantly, a
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Mental health conditions like depression, anxiety, personality disorders, PTSD, and ADHD are among the most common health conditions in the USA. Nearly every 1 in 4 U.S. adults, or 58.7 million people in the country, are living with a mental health condition or disorder. While patients can access mental health services in person, online, or
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Terminally ill patients often rely on hospices to manage their pain and symptoms. However, a day or two in such facilities can cost hundreds of dollars. Therefore, around 1.7 million US citizens are enrolled in Medicare’s hospice program each year to receive affordable end-of-life care. So, how do hospices receive reimbursements? Hospice care specialists use
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Are you tired of dealing with DME’s insurance coverage complications? Outsourcing might be your best bet for tackling billing problems! Durable medical equipment (DME) is listed under the products or supplies category and has different billing requirements, including coding and insurance coverage, than other medical services. Unfortunately, DME billing is a primary target for fraud,
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How confident are you about using the right DME codes? We all know that proper coding can save you from payment delays. But did you know that durable medical equipment (DME) is usually covered by the Healthcare Common Procedure Coding System (HCPCS) instead of CPT codes? DMEs are primarily covered by HCPCS’ level II codes
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