By: Winona Thomas BS HCS According to Kaiser Health News, there has been a spike in retroactive denials for emergency department care and more patients are being caught in the middle of possibly becoming responsible for unresolved hospital bills. Healthcare providers along with healthcare payers are finding challenges with keeping up with the evolving government guidelines for correct claim submissions … Read More
By: Ann Knutson, CPC-A Facility credentialing is a critical aspect of healthcare revenue cycle management. This is the process in which an insurance carrier evaluates a facility for approval to be ‘in network’ and a participating provider of specific healthcare services. According to the Minnesota Department of Health: “Credentialing is the process used to determine if an individual practitioner and/or … Read More
Medical billing and coding is arguably one of the most important aspects of a practice. Quality care, of course, is a priority, but if you don’t bill for the care, your practice won’t succeed. One of the decisions every practice has to make is whether to keep their billing in-house or to outsource to a trusted partner. A few common … Read More
By Ranadene Tapio, MBA, CMRS, CPCS As healthcare delivery gets more complex, patient reimbursement decreases, and patient demand increases, practices are forced to reevaluate their revenue cycle management (RCM) process. Some people underestimate the importance of effective revenue cycle management. RCM is the lifeblood of your practice. It determines almost all key performance indicators and practice health. Along with the obvious indicators, … Read More
Ranadene Tapio, MBA, CMRS, CPCS Collections aren’t the most glamorous part of running a practice. Perhaps the only thing worse than making collections calls is receiving them! Unfortunately, collections are necessary and if done correctly, it will allow you to collect on accounts that have sat stagnant for months, sometimes years. In our years of experience managing collections for small and medium physician practices, … Read More
By Ranadene Tapio, MBA, CMRS, CPCS Does your office experience a rejection rate in insurance denials that’s higher than you’d like it to be? Does your front-desk and billing staff know the type of information that’s important to obtain when registering a patient? Do they know WHY the information they’re collecting is important? We have found, that the first step in … Read More
By Ann Knutson, CPC-A The healthcare revenue cycle includes all administrative and clinical functions that involve capturing, managing, and collecting the provider’s/facilities revenue. The cycle includes three distinct parts of the practice/facility that’s referred to as the front-end, middle, and back end. Unfortunately, most of the time there is little coordination between the three areas which can lead to more claim denials and lost revenue for … Read More
By Ranadene Tapio, MBA, CMRS, CPCS Your practice seems to be doing everything right. You have a team in place, you’ve established your Revenue Cycle Management (RCM) process and you’re submitting claim after claim – but your denial rate isn’t going down. According to the American Academy of Family Physicians (AAFP), the average denial rate is between 5-10 percent. The result is the delay or cancellation of new practice initiatives that … Read More
By Ann Knutson, CPC-A According to the Center for Medicare & Medicaid Services (CMS), medical treatment or supplies provided by a physician is considered medically necessary when they “are proper and needed for the diagnosis or treatment of your medical condition, meet the standards of good medical practice in the local area, and aren’t mainly for the convenience of your … Read More