Medical Billing Blog: Section - Medical Billing
Archive of all Articles in the Medical Billing Section
This is the archive containing links to all articles written in the Medical Billing section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
20 Very Important Aspects of Medical Billing
These 20 aspects collectively contribute to the effective and efficient management of your medical billing process, optimizing reimbursement and minimizing the risk of claim denials. Patient Information: Accurate collection and maintenance of patient demographics, contact details, and insurance information. Insurance Verification: Thoroughly confirming insurance coverage, including eligibility, benefits, and any pre-authorization requirements. Medical Coding: Precise assignment of codes (ICD-10, CPT, HCPCS) to document diagnoses and procedures accurately. Charge Entry: Entering coded information into the billing system to generate claims for submission. Claim Submission: Timely submission of claims to insurance companies, adhering to specific guidelines and deadlines. Claim Rejections and Denials Management: Proactive resolution of rejected or denied claims, identifying reasons …
What are some obstacles to efficient healthcare revenue cycle management?
Efficient healthcare revenue cycle management (RCM) involves various processes, from patient registration and insurance verification to claims processing and reimbursement. Several obstacles can impact the efficiency of healthcare RCM. Addressing these obstacles requires a comprehensive approach, including the use of technology, continuous staff training, regular audits, and staying informed about regulatory changes in the healthcare industry. Common challenges to achieving effective RCM: Incomplete or Inaccurate Patient Information: Inaccurate or incomplete patient data during registration can lead to billing errors, claim denials, and delayed payments. Insurance Verification Issues: Difficulty in verifying insurance coverage and benefits can result in claim denials or delays in reimbursement. Coding Errors: Incorrect medical coding can lead …
The growing importance of patient collections
Patient collections have grown in importance in the healthcare industry for several reasons. Here are some key factors contributing to the increased emphasis on patient collections: Rise in High-Deductible Health Plans (HDHPs): The prevalence of high-deductible health plans has increased, shifting a larger portion of healthcare costs onto patients. As a result, providers need to focus on collecting payments directly from patients to cover these higher deductibles. Increased Patient Financial Responsibility: Patients now bear a greater financial responsibility for their healthcare expenses. This includes co-payments, coinsurance, and deductibles. Effective patient collections are crucial for healthcare providers to recover these out-of-pocket costs. Changing Reimbursement Models: The shift from fee-for-service to value-based …
What is physician insurance credentialing?
Physician insurance credentialing, also known as provider credentialing or insurance credentialing, is the process by which healthcare providers, including physicians, nurse practitioners, and other healthcare professionals, become approved participants in insurance networks or panels. Being credentialed with insurance companies is essential for healthcare providers to receive reimbursement for services rendered to patients covered by those insurers. Here’s an overview of the process: Application Submission: Healthcare providers submit a credentialing application to insurance companies or third-party payers. This application typically includes detailed information about the provider’s education, training, work history, licensure, certifications, malpractice history, and more. Verification of Credentials: Insurance companies or credentialing organizations verify the information provided by the …
Can you save money by outsourcing your medical billing?
Outsourcing your billing can potentially save you money, but it depends on various factors such as the size of your practice, efficiency of the billing process, and the cost structure of outsourcing services. Here are some ways outsourcing medical billing can save you money: Reduced Overhead Costs: Outsourcing eliminates the need to hire and train in-house billing staff, which can reduce costs related to salaries, benefits, office space, and equipment. Efficiency and Accuracy: Professional billing companies specialize in this area and often have dedicated teams using advanced software to handle billing tasks accurately and efficiently. This can reduce errors and rejections, leading to quicker reimbursements and fewer denied claims. Focus …
5 Most Important Aspects of Medical Billing: Melissa’s Mention
Here is an excerpt from an interesting article that has been mentioned by Melissa: “Medical billing is a process where you pay your provider for their services. When we say you, we mean that this is the process where your insurance carrier and you pay the service provider or hospital you were in for deductible charges. Now when you know this let’s put ourselves in the position of a medical institution, clinic, or practice that has to bill for their work. Believe it or not, sometimes it is very hard to do this and these businesses have their work cut out for them when it comes to charging their …
ICD-11: What it is, When it is Coming and How it Will Differ from ICD-10
ICD (International Classification of Diseases) is a universally accepted ranking system used by the WHO (World Health Organization) for categorizing physical and mental illnesses. ICD-11 is the eleventh edition of this categorization system. For about two decades, there have been no development or publishing of an update or revision to the ICD. The official presentation of ICD-11 at the World Health Assembly took place in May 2019 following its release on June 18, 2018. Member states are expected to adopt it as the official reporting system starting on January 1, 2022. However, it is still unknown when the U.S. Healthcare system will be ready to adopt it for use. ICD-11 …
Defining the Role of a Medical Billing Clearing House
The importance of a clearing house in the medical world cannot be overemphasized. Also called Third Party Administrators (TPAs), clearing houses make healthcare payment seamless by serving as a link between the hospital, patient, and insurance provider. The role of the clearing house is to interact with the billing system of a hospital, clinic or physician’s office to evaluate medical claims. It sets up necessary documents for patients with claims before forwarding them to the insurer. Typically, a clearing house has strong ties with various insurance providers. Clearing houses aren’t restricted to just collecting documents and ensuring proper documentation for the claim/claims of patients, they are also saddled with the …
The Importance of A/R and Outstanding Medical Claims
Accounts receivable (A/R) management is an integral part of the medical billing process and it is crucial for the financial stability and success of healthcare facilities and medical practitioners. Accounts receivable is referred to as the sum of money owed to the medical practitioner or healthcare provider for the service provided, but not yet paid. The medical services that are rendered by physicians, nursing homes, therapists, laboratory technicians, and hospitals are continuously increasing. An efficient insurance model assists a medical practice in recovering overdue payments from insurance carriers easily and on time. This is when a diligent A/R employee, or department is important, they assist the healthcare provider in being …
