Top 5 AI Predictive Tools for Catching Claim Denials Before Submission
According to industry sources, healthcare organizations lose around $262 billion every year due to claim denials and underpayments, with almost 20 percent of all claims denied on first review. Revenue cycle management professionals are involved in a tedious process of managing denied claims, which consumes their valuable time and energy. The traditional approach of conducting […]
Why Claim Denials are Rising in Healthcare (And How to Fix Them Fast)
Nationally, first-pass rejection rates range from 9% to 15% based on payer mix and delivery environment. Notably, 41% of payers now experience rejection rates of 10% or higher (Experian Health), while 60% of medical group administrators report a rise in rejection rates over the past year (MGMA). These increases have been driven primarily by payers, […]
What is Lean Healthcare and How Does It Work? Models & Strategies
Think about a surgeon preparing for surgery, but finding out there is no instrument on the tray when needed. Imagine a nurse spending 15 minutes just to find a common medication somewhere in the central supply. Consider an emergency room patient who waits ninety minutes, not because of a lack of doctors at the facility, […]
CPT 92941 Billing Guide for Emergency PCI
In an environment where every second is crucial in the cath lab, correct coding should never be an issue that causes delays. Emergency PCI is a life-or-death, time-sensitive process, and the precision of its coding and billing is as important as the procedure itself. It has a significant impact on both the patient’s health and […]
Understanding the Role of a Virtual Assistant in Medical Billing
There has been a significant shift in how practices handle their revenue cycle in the healthcare industry. A virtual assistant in medical billing has become an essential tool for helping healthcare organizations improve their efficiency and comply with regulatory changes. It allows practices to benefit from the services of qualified remote medical billing specialists, thereby […]
Professional vs Institutional Billing: What’s the Difference?
Mistakes cannot happen when someone’s health hangs in the balance. Yet, oddly enough, clinics often overlook how closely accuracy is tied to cash flow. A frequent cause of rejected claims and delayed payments is the confusion between professional billing and institutional billing; it trips up even experienced offices. Picture yourself managing a clinic and feeling […]
How to Calculate AR Days in Medical Billing: Complete Guide
A steady stream of money keeps a medical office running smoothly. Still, administrators often feel stuck trying to figure out why checks arrive late or income slips through unnoticed. One number matters most when checking if finances are on track, and that is, AR Days in Medical Billing. What does this term really mean, though? […]
Avoiding Claim Denials: The Guide to Couples Therapy CPT Codes
We can relate to your level of frustration when your claims are denied despite providing vital mental health services. Couples therapy is among the least understood areas in mental health insurance, causing couples therapists to miss out on income. Therapists are often unaware of individual therapy CPT codes when both clients are present, or are […]
Understanding CPT Code 99213: A Simple Guide for Medical Billers
The most frequently utilized code for established patients visiting the doctor’s office is the CPT Code 99213. It is vital for any party involved in the billing process to grasp the importance of the CPT Code 99213 and the specific meaning of the code itself. To the medical biller, the importance of the code is […]
Common Medical Billing Errors That Violate US Regulations
Managing the complexities of healthcare reimbursement has proven challenging for providers nationwide. However, when the process goes wrong, medical billing errors become a serious issue. In the United States, billing compliance does not simply mean receiving payment; it involves complying with federal and state regulations, including HIPAA and the False Claims Act. What begins as a […]