Medical Billing FAQs

Medical billing is an intricate process that can make anyone edgy with varying insurance payer guidelines and ever-evolving billing and coding requirements. Medicare and Medicaid are the two biggest insurance coverage programs administered by the US federal and state governments, respectively.  Medicare has over 65 million, while Medicaid has over 72 million beneficiaries. Thus, as […]

Credentialing in Medical Billing could be the one thing that stands between you and reimbursements. According to the Medical Group Management Association (MGMA), around 54% of medical practices agree that the rate of claim denials has increased because provider’s credentials are not approved by insurance payers.  Don’t let this be your story. Learn everything that

Is your practice struggling with a high contractual adjustment rate (CAR), affecting your payment cycle and revenue health? If yes, then this guide is for you! We will discuss what this adjustment means, its rate, industry benchmark, group codes, and allowable rate. Some effective strategies have also been shared to help you improve the contractual

Artificial intelligence (AI) and automation are revolutionizing almost every industry, and healthcare is no different. However, not everyone can gauge its full potential. It is impossible to cover all the facets of healthcare that could benefit from this technology in a single blog.  BUT! As a healthcare provider, you must be concerned with keeping your

What is upcoding in medical billing? Well! It is a coding error that can make insurance companies pay more than what they owe the provider. But things are not as simple! This coding error can also be termed fraudulent activity, costing you your reputation and resulting in heavy penalties, such as cancellation of your practice

Identifiers are necessary for processing online information. An entity code is exactly that! This medical identifier labels different entities (individuals) involved in the billing process, including healthcare providers, such as doctors, hospitals or clinics, patients, insurance companies, or a third-party billing service. If you are a healthcare or medical billing professional, you might already understand

Healthcare facilities struggle to stay profitable amidst reimbursement cuts and ever-evolving regulations. A/R, or accounts receivable in healthcare, is one of the many metrics that need constant monitoring to avoid flushing your rightful payments down the drain. This comprehensive guide will explore it in detail. We will start by discussing what is A/R and what

In the rapidly evolving digital age, industries worldwide are undergoing significant transitions, and the healthcare sector is no exception. One notable change in healthcare is the transition from traditional paper-based medical billing methods to more efficient and accurate digital billing systems. However, the shift was NOT sudden. It happened gradually, and with the popularity of

Medical billing is a daunting task that requires time, effort, and attention to detail. On the other hand, claims adjudication is nothing short of a nightmare for most healthcare providers. Why? You will get the answer in this guide. So, continue reading! After you submit a patient’s claim to their insurance provider, the provider reviews

ICD-10 has five times more codes than ICD-9, making it a more precise coding system. Thus, it makes sense that healthcare practitioners frequently wonder how to use unspecified codes or avoid using them altogether.  In the ICD-9 coding system, it was common to use unspecified codes. Contrarily, in the ICD-10 coding system, using codes without