Medical Billing and Revenue Cycle Management

  The healthcare industry is constantly evolving, and medical billing is no exception. The ever-changing regulatory landscape, complex insurance plans, and increasing patient volumes can make it difficult for healthcare providers to keep up with their billing and coding needs. This is where outsourcing medical billing services can come in handy. Outsourcing medical billing services  to a qualified provider can help healthcare practices improve their revenue cycle management, reduce costs, and free up their staff to focus on patient care. Here are some of the key benefits of outsourcing medical billing services in 2023: •  Improved revenue cycle management : Outsourcing medical billing services to a team of experts can help you improve your revenue cycle management by ensuring that claims are submitted accurately and on time. This can lead to a significant increase in your revenue. •  Reduced costs:  Outsourcing medical billing can help you reduce your costs by e...

  In order for value-based healthcare to succeed, it is imperative that physician practices effectively articulate the medical services and procedures they provide. This underscores the vital role of the Current Procedural Terminology (CPT®) code set in driving the shift towards value-based care. According to the chair of the AMA/Specialty Society Relative Value Scale Update Committee (RUC), value-based care hinges on a standardized terminology with a long-established track record, enabling quality comparisons and ensuring continuous, demonstrable enhancements over time. Value-based care aligns payment with the actual outcomes and quality of services, ensuring equity and cost-effectiveness. With evolving payment models demanding greater accountability and risk-sharing from physicians, the significance of the CPT code set is amplified, emphasized by an MD, chair of AMA/RUC, a distinguished diagnostic and interventional radiologist based in San Antonio. He underscores the continued i...

  On Thursday, the Biden administration revealed its intention to eliminate medical debt entries from Americans’ credit reports, aiming to put an end to what it views as coercive debt collection strategies affecting a wide swath of consumers. The proposed measures are designed to extend a financial lifeline to families grappling with medical crises, curbing the practice of debt collectors pressuring individuals to settle bills they may not legitimately owe. Additionally, the plan seeks to ensure that creditors rely on accurate data, free from the inaccuracies and errors that often plague credit reporting. The Vice President, who also serves as the leading consumer finance watchdog, conveyed that over 100 million Americans are currently burdened with unpaid medical debt. They underscored that many of these debts arise from unforeseen medical emergencies, emphasizing how credit scores are instrumental in determining a person’s economic well-being and their capacity to build wealth. T...

  According to a survey, claim denials are considered the biggest obstacle in revenue cycle management, with over 20% of providers reporting an annual loss of $500K due to these denials. A recent survey of healthcare leaders conducted by  leading medical billing company  revealed that claim denials are causing a significant and costly issue for healthcare revenue cycle management (RCM). The survey included several healthcare organizations with annual revenue ranging from $25 million to $5 billion and RCM teams consisting of 50 to 700 people. The survey found that more than half of the respondents (58 percent) ranked claim denials as their organization’s greatest RCM challenge, second only to “specific payer challenges” (44 percent). Other RCM challenges included staffing (41 percent), cost of collections (26 percent), and policy changes like The No Surprises Act (21 percent). The survey also showed that nearly 42 percent of respondents reported that denials management is ...

  Ensuring accurate reimbursement is essential for every physician’s practice. Regrettably, shortages in coding staff, backlogs in charting, and shifts in guidelines frequently result in denied claims and financial loss. While various remedies have been devised, only coding automation has the potential to genuinely address this issue. Below, we’ll explore seven ways in which this AI technology enhances revenue capture. However, before delving into these, it’s crucial to grasp the fundamental reason why coding poses a burden for many practices today. The primary issue in the current medical coding process: When considering the fundamental challenges in coding today, various concerns arise – expenses, time investment, the persistent shortage of coders, and the added administrative burden on your practice. However, the underlying issue revolves around perspective: practices often accept the current state of affairs without recognizing there are alternatives. Traditionally, administrat...

  Residing in a location with exceptional medical facilities has its advantages, but regrettably, it doesn’t always protect us from the intimidating possibility of medical expenses that can alter our lives. Though treatments that save lives can be a boon, the subsequent financial strain can be daunting. In the last eighteen months, the Media industry has effectively assisted individuals in reclaiming over $500,000. They conscientiously monitor every penny restored to individuals through their intervention, and a substantial portion of these reclaimed funds are attributed to medical expenses. The encouraging news is that you also possess the ability to assert control over your healthcare finances. https://www.allzonems.com/how-to-tackle-expensive-medical-bills-5-tips/ Medical billing services for medical practices Medical billing services are important for medical practices to receive timely payment of medical claims. Knowing the step-by-step medical billing process ensures medical ...

  In the ever-evolving world of healthcare, revenue cycle management (RCM) plays a crucial role in the success of any medical practice. Efficient RCM ensures timely and accurate payment for services rendered, which can significantly impact the financial health of a practice. To help you navigate the complex world of RCM, we have put together a comprehensive guide with 13 steps that every practice should follow. Step 1: Verify Patient Insurance Eligibility Before any services are rendered, it is essential to verify the patient’s insurance eligibility. This step ensures that the practice is aware of any co-pays, deductibles, or out-of-pocket expenses that the patient may be responsible for. Step 2: Collect Patient Information Collecting accurate patient information is crucial for successful RCM. Make sure to obtain complete demographic and insurance information from the patient at the time of scheduling the appointment. Step 3: Schedule Appointments Efficiently Efficient scheduling p...

From the inception to the conclusion of the Revenue Cycle Management (RCM) pipeline, it is imperative for practices to implement enhanced analytics and streamlined workflows. Healthcare providers have grappled with the challenge of receiving proper compensation for their services, and the current reimbursement landscape presents even greater obstacles compared to previous years. Payors are persistently exploring avenues to deny claims and prolong physician enrollment, while the lingering effects of the pandemic on staffing and financial resources further exacerbate the situation. Addressing these hurdles necessitates thoughtful solutions for healthcare organizations (HCO’s), encompassing staffing shortages and technological limitations, as well as adoption issues. As organizations find themselves equipped with more comprehensive data, the focus shifts to optimizing analytics and ensuring seamless workflows throughout the RCM pipeline. A few years ago, the primary obstacle revolved arou...

  In the fast-paced world of cardiology, billing can often be a time-consuming and complex process. However, with the right strategies and tools in place, it is possible to streamline your cardiology billing and achieve greater efficiency. Here are some tips to help you get started. 1. Invest in a Robust Billing System One of the most important steps you can take to streamline your cardiology billing is to invest in a robust billing system. Look for a system that is specifically designed for cardiology practices and has features such as automated charge capture, claim scrubbing, and electronic remittance advice. A good billing system can help you reduce errors, increase accuracy, and improve the speed of your billing process. 2. Stay Up-To-Date on Coding Guidelines The coding guidelines for cardiology procedures are constantly changing. In order to ensure that you are accurately coding your claims, it is important to stay up-to-date on the latest guidelines. There are a number of r...

  Discover how healthcare providers can accelerate cash flow, minimize denials, reduce operational costs, and enhance patient satisfaction through streamlined   Revenue Cycle Management (RCM) . RCM is a strategic approach to overseeing all financial aspects of a patient’s journey, from initial appointment scheduling to final bill payment. This article highlights the critical role RCM plays in maximizing revenue and efficiency in healthcare organizations. Accurate and comprehensive patient information is paramount for RCM success. Efficient patient registration and insurance verification processes ensure that providers have the necessary data to initiate billing accurately. The coding process is pivotal in generating precise claims, converting medical procedures and services into standardized billing formats for insurance companies. Timely claim submission is crucial to expedite payment, with RCM teams monitoring claim statuses, following up on denials, and resubmitting when ne...

  Debridement is a process that involves the removal of foreign material, as well as tissue that is either devitalized or contaminated, until healthy tissue is revealed. Its primary purpose is to clean the affected area and is often performed concurrently with other orthopedic surgical interventions. In my role as an auditor specializing in orthopedics, I frequently encounter situations where healthcare providers submit claims for debridement in addition to extensive surgical procedures. Nevertheless, from a billing perspective, debridement is typically regarded as an integral component of a more comprehensive surgical procedure. According to the National Correct Coding Initiative (NCCI) Policy Manual, Chapter 4, in its General Policy Statements section, it is stipulated that ‘Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately billable.’ This may seem straightforward at first, but as is often the case with  orthopedic coding , th...

  In this article, we discuss the benefits of coding and case management (CM) collaboration – in particular, the value of CM documentation. By no means is this going to be an article about how case management should be cross-trained to learn coding. However, we believe there is value in coding professionals being able to engage in discussions with case management regarding the role of case management documentation in the coding process. Specifically, we want to emphasize how clear documentation on patient dispositions and social determinants of health (SDoH) risk factors can greatly enhance record integrity. As we have discussed in previous articles and broadcasts, there is no better way for coding to gain insight into and accurately capture Z-codes than by leveraging the descriptive documentation provided by case management in their initial assessments and ongoing progress notes related to patient involvement, including SDoH risk factors during hospitalization and their impact on ...

Hospitals contend that the 3.1 percent increase in payments linked to quality reporting is insufficient to address the rising inflationary pressures. The Centers for Medicare & Medicaid Services (CMS) has officially published the final rule for the Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS) in the Federal Register on August 28. Effective from October 1 for fiscal year (FY) 2024, there will be a 3.1 percent rise in operating payment rates for general acute hospitals falling under IPPS. This marks a 0.3 percent increase over the agency’s initially proposed 2.8 percent increase in April. The 3.1 percent hike applies to general acute hospitals that actively participate in the Hospital Inpatient Quality Reporting (IQR) Program and demonstrate meaningful use of electronic health records (EHRs). According to the CMS’ FY 2024  IPPS and LTCH PPS final rule  Newsroom Fact Sheet, hospitals will experience var...

  Numerous pre-claims management factors significantly influence the revenue cycle, underscoring the critical importance of optimizing front-end processes for a healthcare provider’s financial prosperity. The healthcare revenue cycle comprises three distinct phases: the front-end, mid-cycle, and back-end. While significant attention is often given to mid and back-end functions, such as coding and billing, claims management, and denials management, it is imperative to recognize that actions preceding a clinical encounter can profoundly influence revenue cycle efficiency. Front-end revenue cycle procedures encompass essential tasks like patient scheduling, insurance verification, financial counseling, and upfront patient collections, among others. These functions play a pivotal role in ensuring the accurate and timely generation of claims and revenue collection. However, healthcare providers frequently face numerous challenges within the front-end revenue cycle processes. For instanc...