Medicaid is a joint venture of state and federal programs whose aim is to facilitate low-income families and individuals with healthcare coverage. The patient eligibility criteria to qualify for this program is that one must be a state resident in which they receive this insurance program. The patient must be either United States resident or lawful permanent resident (non-citizen). Furthermore, some eligibility groups are limited by pregnancy, age, disability, or parenting status. In some states, Medicaid programs have expanded to cover older adults below a certain income level. Patient eligibility criteria for this program vary from state to state due to particular states’ Medicaid programs. However, specific qualification criteria for the Medicaid program are mandatory for all states to follow. The article will discuss the fundamental requirements for the eligibility of patients. Read More...
Uncover the significance of Medicare Physician payment reform within the latest blog entry. Incentive’s quality healthcare requires immediate attention from lawmakers. Discover how technology can transform patient interactions and provider workflows. Join forces to promote favourable modifications for a sustainable healthcare ecosystem. Read more...
Medical billing errors are periodic statements or reflections of an extension of credit not made to a person or consumer who has implied, actual or apparent authority to use a credit card or open-end credit plan. It happens when healthcare professionals bill patients for services they have not received or incorrect services. Medical billing error also occurs when scheduled services of patients are included in the billing and later canceled. These errors also included misapplied payments, billing error calculations, statement errors, or unrecognized statement changes. As a result, medical professionals have to face denial claims, delayed payments, and some, it turns out, in the form of substantial financial loss. The article will discuss 10 common errors in medical billing to help you avoid all hazards that happen in medical billing. Read More...
Compliance in medical billing and coding is of prime importance in ensuring the ethics and integrity of the healthcare system. The spotlight on ethics in the healthcare business has partly been due to the crisis in confidence about online websites and a lack of public trust. Furthermore, a complex healthcare organizational environment where administrations are required to juggle a ‘multitude of competing regulatory obligations and interests’ has provided fertile ground for ethical dilemmas. The trend is evident in the growing concern over the inappropriate conduct of coding and billing and raising claim denial and rejection issues. That is why medical coding and billing effort should fully comply with the guideline of regulatory authority because ethical problems will eventually lead the health professional and healthcare business to potential or immediate legal troubles. Ethical issues also contribute to losing goodwill and public image and ultimately reduce business profitability. Thus why, a process is required for strict adherence to regulatory guidelines to protect the patients, payers, and healthcare providers. The article will discuss the role of compliance in medical billing and coding. Read More...
Navigating insurance denials is a hectic and time-consuming task. Insurance companies always try to find reasons to deny the claims. Claim denials most stem from a lack of information, misinterpretation of claim facts, or misapplication of insurance law by the insurance company. If the claim is denied initially, it is essential to immediately respond to the denial to provide the insurance company with accurate facts and laws supporting the coverage. Meanwhile, I also request the insurance company reconsider its coverage position. However, medical billers and healthcare professionals must appeal for denied claims to ensure proper reimbursement. In medical billing, effective denial management is also crucial because denied claims can reduce revenue cycle management. The article will discuss essential tips that help handle claim denials and increase the chances of a successful appeal. Read More...
Medical billing software is a medical technology solution that automates medical billing tasks and also contributes to optimizing business management processes. It is a contemporary automation of conventionally manual practices like claim management and medical billing. There is a list of billing software used in medical practice; however, the best medical billing software depends upon the requirements and your specific needs. Excellent workable and famous medical billing software options are available in the market. However, choosing the right medical billing software helps healthcare providers optimize their revenue, improve reimbursement rates, and contribute to building a sustainable medical practice. Understanding selecting the best software to quench your needs starts from your office. The best choice of software is one that helps you to schedule your appointments and automatically enter the correct information of patients. The article will discuss the different factors to consider while choosing the right medical billing software for your medical practice. Read More...
Clinical Documentation Improvement (CDI) has a pivotal role in prosperity and streamlining the processes of the healthcare industry. It allows healthcare professionals and insurance companies to capture comprehensive, accurate patient information. The enhanced quality of Clinical Documentation Improvement allows better care of patients, strengthens the integrity of healthcare data, improves regulatory compliance, and optimizes the revenue cycle. Furthermore, enhanced Clinical Documentation Improvement is also essential for healthcare professionals to deliver quality care, ensure patients’ safety, and effective communication and support appropriate reimbursement. Clinical Documentation Improvement focuses on enhancing healthcare documentation’s specificity, accuracy, and completeness. This article will explore the strategies for improving accuracy with Clinical Documentation Improvement (CDI) in medical billing. Read More...
The goal of every individual in the workplace or job is to generate profit in life, even sometimes at the stake of violating ethics. Compliance is how to follow the rules while working in the healthcare industry. The Physicians should have compliance knowledge to ensure the business’s success and ethical business practices. Compliance ensures that all working methods rule CPT, HIPAA, and CMS. Physicians intend to follow these rules in the healthcare industry to benefit businesses and physicians. Under current circumstances, the role of healthcare laws and regulations cannot be denied to avoid the risk of billing and claim denials. Physicians must be aware of the four common compliance mistakes to pursue a successful and smooth healthcare practice in the contemporary and dynamic healthcare system. The article will not only discuss these four common compliance mistakes but also share actions that help to avoid these common compliance mistakes. Read More...
In house and outsourced medical billing services are adopted to capture medical industry power and create the ability to enhance medical billing efficiency and revenue cycle management. It is a concern in deciding between in-house and outsourcing medical billing services. It is a diversification strategy used to determine the autonomy of healthcare business units. It is adopted when there is a high gap between the service cost, service efficiency, and maintenance of accuracy. Medical billing outsourcing or in-house services are highly unpredictable, and the company needs more sources to establish the environmental gap. In such a situation, various factors become necessary to consider the execution of business operations. Outsourcing or in-house of medical billing services becomes possible when it helps to reduce the cost overhead, increase billing efficiency and provide assistance in regular processes. The article will discuss the significant differences between in-house and outsourced medical billing and analyze both to make an accurate choice for healthcare providers. Read More...
Welcome to our comprehensive guide on patient consent statements! Patient consent statements are significant in the healthcare industry as they ensure ethical and legal procedures. Are you a healthcare professional? A patient? Or maybe you are just interested? Well then, buckle up because this blog post will give you some great insights into patient consent statements! So, let’s dive in! Patient consent statements are serious documents that state a patient’s approval or permission for specific medical procedures, treatments, or the exchange of personal health information. These statements serve as a means to protect patient’s rights, privacy, and autonomy. When healthcare providers get informed consent, they make sure that patients know everything about their healthcare decisions. Read More...