Improved and Optimized Denials and Appeals Processes
A multispecialty clinic located in Manhattan, New York that is a leading provider of healthcare services. It has 10 doctors, 8 Nurse Practitioners, and over 100 employees. The clinic serves over 300 patients per day from its 5 locations and is associated with most of the hospitals in the region. It has a revenue of […]
Navigating the Challenges of Patient Access in Healthcare
Patient access marks the start of the patient journey and produces a lasting impact on the individual patient’s experience. An effective process ensures timely access to necessary medical services and efficient operation can have a significant impact on the financial performance of healthcare organizations.
Innovating Together: RCM Team Strategies for Success
A smooth revenue cycle management is super important for any medical practice. Without it, things can get pretty chaotic. A good RCM helps optimize medical billing and revenue collection, making it easier to handle billing and coding issues that healthcare systems often face. After all, a medical organization’s financial health is just as important as […]
Understanding Prescription Insurance Claims Process
The prescription insurance claims process begins after a pharmacy submits a claim, and then it is routed to the appropriate insurance company or Pharmacy Benefit Manager (PBM). The pharmacy then verifies your insurance coverage and submits a claim to the insurance company. The insurance company then reviews the claim, approves or denies it, and if […]
Revenue Cycle Management Deficiencies & Accumulated AR
Effective revenue cycle management (RCM) is the lifeblood of any medical practice or healthcare organization. It ensures the financial health and sustainability of the entity, enabling it to provide top-quality patient care.
Healing Beyond Horizons: How Sustainable Practices in Healthcare Clinics Impact Patient Well-being and the Future
IntroductionIn the quest for a healthier future, healthcare clinics are recognizing the pivotal role they play in promoting sustainability. Beyond the confines of traditional patient care, sustainable practices are emerging as a beacon for improved well-being. This blog delves into the profound impact of sustainability in healthcare clinics on patient well-being and the transformative influence […]
Trends in Insurance Billing and Revenue Cycle Management
Introduction In the healthcare industry, claims and revenue cycle management (RCM) are constantly evolving. An important aspect of healthcare management plays a key role in ensuring the financial stability of healthcare providers. Several trends are emerging in how organizations approach insurance claims and RCM, contributing to increased efficiency and adaptability in the face of ever-changing […]
ICD-10-CM Coding Updates 2024
As we step into the fiscal year 2024, the ICD-10-CM code set is undergoing a significant update. This comprehensive revision encompasses the addition of 395 new codes, the removal of 25 existing codes, and modifications to 22 codes (including nine with changes to the short title only). Here are some key changes by Section.
Strategies for Successful Insurance Claims Processing
Introduction In the complex field of healthcare management, successfully handling insurance claims is a critical component for healthcare providers seeking financial stability and optimal patient care. Efficient claims processing ensures timely reimbursement, reduces administrative burden, and provides a seamless healthcare experience. This article explains the key strategies currently important in managing claims processing complexity and […]
Credentialing and Privilege: Understanding the Distinction
Introduction In the complex healthcare environment, the terms “Credentialing” and “Privilege” are important elements to ensure the competency and qualifications of healthcare professionals. Although these terms are often used interchangeably, they play different roles in healthcare settings, and each contributes uniquely to the quality and safety of patient care. Credentialing: The process of reviewing and […]