Medical Billing and Coding

It is true that patient volumes continue to be high for the urgent care centers. Most of the clinics are finding it difficult to meet patient demands with employees facing burn out issues as they are understaffed. Health related issues with this pandemic are one of the major reasons for shortage of staffs.  Work/Life balance is now a priority and on top of everyone minds. While urgent care centers are still providing a better balance for any emergency center or a hospital, it still cannot compete with any other industry as there are no weekends. In fact, the major backlogs have started happening during the weekends as providers remain hugely understaffed.  The need of the hour for any urgent care center is to explore possibilities on how they can focus on their patients, handle what they do best while someone else can handle their billing priorities. A quality urgent care billing company knows how to offer customized support with trust and excellence. The Sunknowledge assuranc...

The market for Durable Medical Equipment is now valued at more than USD 5.9 billion and is predicted to increase at a compound annual growth rate (CAGR) of 6.0 percent during the forecast period. The demand for the DME billing industry nowadays has largely led to the factors such as:  An elderly population is on the rise.  There has been a significant increase in the number of persons suffering from sleep apnea and respiratory ailments.  Injuries, particularly those resulting from sports injuries, etc . There is a clear divergence in the billing procedure for DME treatments and other therapeutic services. Some of the most serious challenges that any DME service faces are those that are not covered by Medicare, Medicaid, or any commercial health insurance plan.  While physicians have the prerogative of prescription DMEs as a crucial component of therapy, they must provide a severe cause for doing so, as well as proper verification of the same with a medical need. Man...

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 ...