Medical Billing FAQs

How often do you receive prompt payments for your services without any rejections? Payers deny most medical claims due to billing errors, such as incomplete or missing patient information, mismatched coding, lack of pre-authorization, and missed deadlines. The problem is so severe that according to Premier’s voluntary national survey of 2023, insurance companies, on average, […]

Every year, hospitals in the USA report nearly $50 billion in bad debt, and 30% of the hospitals (one in three) incur a bad debt of over $10 million. That’s a lot of money being written off!  Write-offs in medical billing are a frequent occurrence. While some write-offs are happily agreed upon by the provider

Many tasks and actions like construction, business operations, and large public gatherings require permission. In medical billing, healthcare providers also need permission to perform certain procedures or services. This extra step is called pre-authorization (PA), or prior authorization in medical billing. But why is authorization so important in medical billing? Insurance companies use the prior

How do you handle patients with more than one insurance policy? It can be frustrating to file multiple medical claims for the same patient manually. However, the process becomes much easier if your client is eligible for supplemental Medicare benefits.  This dual eligibility leads to Medicare automatically crossing over your medical claim to Medicaid or

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