Medical Billing and Coding

The value of Hospital Accounts Receivable is a high-risk field. It is extremely sophisticated, and because it is based on assumptions and estimation, it is prone to errors and fraud. But that's only the beginning. Hospital Accounts Receivable is compounded further by frequent regulatory changes, ever-changing payment methods, increased usage of high-deductible health plans (HDHPs), and the addition of vast pools of formerly uninsured persons driven into health plans by the Affordable Care Act (ACA). To make matters more difficult, collection varies by patient and plan, and collection timeframes might range from days to years. As a result, many present Hospital Accounts Receivable valuation methodologies are not adjusting effectively, and businesses must figure out how to evaluate and calculate impacts, as well as make modifications to account for them. Many established Hospital Accounts Receivable rules and procedures aren't changing properly, and organizations have to deal wi...

The primary goal of a well-managed radiology billing operation is to submit claims for services on time and in the correct format for getting timely compensation. The services that require pre-approval from the ordering physician are: • CT (computerized axial tomography)  • MRI (magnetic resonance imaging)  • MRA (magnetic resonance angiography)  • PET (positron emission tomography) • Cardiac nuclear medicine investigations (nuclear heart stress test) In the majority of cases, extremely time-sensitive treatments must be accomplished within a specific time range in order to initiate a treatment plan. As a result, prior authorization is critical for reducing wait duration in availing radiography services.  Your patients should not be kept waiting for too long as this will result in out-of-pocket charges. Delays can be avoided with professional assistance, which shortens the approval process. However, some errors are difficult to avoid because they result from a lack o...

Hearing the term DME prior authorization can send shivers down the spines of physicians and healthcare professionals. If we looked up the term "prior authorization" in a dictionary, the word "burden" would appear right next to it. DME Prior authorizations have been in place for decades, but nothing has been done to alleviate the load on doctors. According to a 2019 poll performed by the Medical Group Management Association (MGMA), 90% of responders noticed an increase in DME PA requests over the previous year. It's no wonder that DME prior authorizations are a tax on clinical resources, according to those same respondents. Large healthcare systems around the country are working to improve their DME PA processes, which will result in considerably speedier DME prior authorizations for customers. To improve the DME prior authorization process, much of the effort is being put into documenting existing processes and applying best practices within the existing workflo...

Your Hospital Accounts Receivables (AR) department is the heart of your practice's financial health, but is it operating at peak efficiency? Improving Hospital accounts receivables administration is simple, and it will pay you handsomely in improved revenue from fewer claim denials and time spent on repetitive chores and rebilling.  Improve your Hospital Accounts Receivable and your cash flow  A high Hospital Account Receivable impedes cash flow and, as a result, the operation of your practice. Here are eight things you can do to improve your Hospital Account Receivable: Tip1: Produce Hospital Account Receivable Documents  Run Hospital Account Receivable reports every month to keep track of Hospital Account Receivable trends and changes. These reports should include aged receivables so that you can monitor the status of older bills. To determine billing schedule difficulties, run these reports from the service date rather than the billing date. The MGMA prefers to see no...

 A medical biller creates the bill based on the inputs provided by the healthcare coder and sends it to the insurance provider to collect the patient's charges. Even though HME billing looks to be simple, it comes with its own set of obstacles. HME billing encompasses a broad range of services. • Coding  • Protocols  • Data Entry  • Documentation  As a result, human error, among other things, is always a possibility. In this circumstance, task automation can assist lower error rates. The following five important advances in the HME billing business will almost certainly be the consequence of artificial intelligence (AI). Code correction is automated There are thousands of codes in the medical field as a whole. Almost every year, a unique set of criteria is added to the list. As a result, medical coders must work even harder to stay up. Even after all of the codes have been connected to the network, glitches continue to remain. Errors are costly in terms of both ...

DME Prior authorization (PA) stands in the way of physicians providing care to their patients, and the process needs to be improved. Learn why this topic caught the attention of patients, physicians, politicians, and other stakeholders in health care in 2021.  DME Prior authorization is a cost-cutting mechanism used by health plans that require physicians to obtain approval prior to delivering the recommended treatment or required service in order to qualify for payment. The DME prior-authorization resources are here to help with: Reform Increase practice efficiency  Give statistics  To demonstrate the need for change. Here's why DME Prior authorization became such a heated topic this year Reason1: DME Prior authorization imposes a significant burden  According to an AMA survey of 1,000 practicing physicians, medical practices pay an estimated two business days each week. This is to comply with health plans expensive and underutilized DME Prior authorization procedur...