Revenue Cycle Management

Medical claims adjudication is when the health insurance company reviews medical claims and settles or denies them. This is done through a cross-analysis with the patient's benefits and coverage specifics. Automated claim adjudication in medical billing offers hassle-free and timely...

Denial in terms of healthcare is the denial by an insurance company to pay for a patient's medical treatment. Denials often hinder the course of care for people and result in loss of revenue for providers.  

In the U.S, medical coding is the creation of medical codes that identify with specific diagnoses and services in the healthcare industry. These codes are identified through medical documentation and used to determine billing details, and the efficient use of...

With virtual health practices like telehealth and mHealth coming up, it is becoming more critical to manage bill payments and claims to process systematically. The medical billing cycle is a complex system consisting of processes, including medical records management, patient data management, etc. Medical claim processing forms...

Clinical IT solutions can go a long way in reducing overall costs and increasing efficiency in healthcare. Ranging from hospitals to independent clinics, all healthcare organizations place cost efficiency and service excellence among their priorities. Automation of clinical IT systems...

With time, the government implemented specific regulations to improve the healthcare industry. The medical Coding and classifications system is also one regulation that providers and insurance companies follow for a smooth transfer of care service claims. Medical coding systems are...

Home, car, property, business, and travel – can you think of a word that can bind all these together? Insurance. Investing in insurance is good, but ask anyone who has claimed insurance, and they will tell you it’s far from...

Applying automation to healthcare and medical claims management solutions can go a long way in reducing overall costs and increasing efficiency across the board. Ranging from hospitals to independent clinics, all healthcare service agencies state cost efficiency and service excellence...

In the U.S., medical coding is the creation of medical codes that identify with specific diagnosis and services in the healthcare industry. These codes are identified through medical documentation. These codes are used to determine the details of billing, and...

The process of analyzing large chunks of data to discover meaningful patterns and trends through complicated mathematical calculations that offer predictable outcomes.

Healthcare organizations and caregivers race against all odds to boost revenue and improve quality care. And professionals adopt a myriad of strategies and approaches for the same. However, a significant roadblock in delivering effective care is the lack of faith...

Healthcare credentialing refers to the process where medical organizations verify providers' credentials to make sure that they have the necessary licenses, certifications, and skills required to provide proper care services for patients. It is also known as physician credentialing, medical...

Credentialing in medical billing is mandatory, and insurers require health practitioners. It is so that health providers can serve insurers' customers after verifying themselves.  

The manual process of healthcare credentialing is tedious and time-consuming. Considering the paperwork involved, it can take 2-3 months to complete the physician credentialing process. Complex applications, arduous reviewing, stringent background checks, cross-checking procedures, and validation of licenses and certifications...

An integral part of the medical billing process – credentialing – is becoming a trusted healthcare provider with an insurance company. If done correctly, it will allow the healthcare organizations to be listed on an insurer's network. Every insurance provider forms a...

Credentialing for physicians is a process that verifies that doctors and other medical professionals are sufficiently trained and have all the necessary certifications to provide the specific healthcare service to patients. This process is integral toward maintaining care standards and...

Healthcare Credentialing is an uphill task. With the growth of technologies like EHR and mHealth, healthcare IT experts have developed various applications to manage and simplify complex healthcare tasks. However, earlier, it was mainly a manual process, but these processes are automated...

Patients go to doctors without much knowledge about their qualifications and certifications. Sometimes what meets the eye may be deceptive. Doctors may lack the certification required to render certain care services, which could pose a huge risk, besides going against...

‘Tell me about your experience and educational background,’ sounds familiar? Chances are you must have faced this classic job interview question at least once in your lifetime. A person or business with good credentials finds favor in every profession and...

A medical billing solution provides enormous convenience for a healthcare provider regarding administrative activities. Medical billing procedures involve complex steps that need to be done right for the providers to get paid on time.  

Pharmacists often have to help people understand prescriptions and offer guidance about dosage and alternatives. Additionally, they must also handle day-to-day operations like managing their inventories, preparing prescriptions, and looking after billing and insurance while adhering to regulations.  

If a claim is denied, your entire medical practice gets affected, and the medical billing management slows down. Physicians must receive payment for the hours of care services invested. Errors in medical billing systems can impact healthcare businesses' payment processing...

Healthcare management's success depends on many aspects- care delivery, staff satisfaction, revenue growth, and more. However, revenue is an essential subject that providers are quite concerned about. And a lot depends on the hospital billing system. It's the providers' job to deliver...

Technology in healthcare is growing by leaps and bounds. Services as solutions like mHealth, electronic health records, patient engagement systems, and more are improving the healthcare industry today. Interestingly, providers also are investing in custom healthcare solutions that cater to their practice needs.    

As the world continues its fight against Covid-19, healthcare organizations are looking for innovative ways to mitigate recent challenges. From telemedicine to remote access, software solutions offer answers to address value-based caregiving. Among other things, medical billing processing needs to be designed to address...

Medical billing software enables healthcare organizations to digitize the activities in the billing process. Not only does it digitize, but it also helps providers consolidate medical billing and reduce overhead. Medical practice billing software optimizes non-medical administrative activities for healthcare...

The medical billing process in the healthcare industry is a heavy-duty job that involves a plethora of complex data on medical records, patient information, insurance claims, etc. All of these processes involve a mountain of paperwork and complexities for healthcare professionals...

Medical billing mistakes can be easily made, but have drastic repercussions on the overall profit of the healthcare organization. Returned claims with errors, denied claims, rejected bills, incorrect coding, and insufficient data are just a few of the many woes...

Healthcare organizations can reap immense benefits from an agile and efficient medical billing app. An automated coding and billing software, relieves the healthcare staff to focus on clinical processes and medical treatment, with a focus on increasing patient satisfaction. Medical...

As healthcare systems brace for the present and future challenges, the reality lies in reassessment. Reviewing the system involves a check on system efficiency, operational capacities, and billing accuracy. Patient needs require accurate and efficient billing processes, which can be...

As the medical care industry faces unprecedented challenges due to the Covid-19 pandemic, medical billing management has been exposed to its own set of dilemmas. As infections across the nation grow with the Covid-19 outbreak, the health and safety of...

A major factor that complicates healthcare in the United States is the system of payment. Reimbursement for medical billing services is an elaborate process that includes multiple steps to be done correctly. It might take some days or weeks if...

Multiple layers of regulation have made American healthcare extremely complex. There is an elaborate, bureaucratic process for providers to enter and process patients electronic health records, fill out claims and finally get paid. On top of that, the covid-19 pandemic has...

The healthcare industry in the United States is complex, with multiple layers of regulations that are subject to changes. As a result, providing medical services and getting paid for them is often complicated. Healthcare revenue cycle management platforms (RCM platforms)...

Medical billing mistakes can be easily made but have drastic repercussions on the overall profit of the healthcare organization. Returned claims with errors, denied claims, rejected bills, incorrect coding, and insufficient data are just a few of the many woes...

The healthcare sector is a service-providing industry, where patients are the main focus. However, the revenue cycle forms an essential component of healthcare, where many providers struggle. Effective medical billing and reimbursement demand that healthcare leaders communicate well and work together to...

The complexity of the healthcare industry in the United States is unlike anything seen in any other country. American healthcare is a meandering labyrinth of evolving regulations that hospitals must keep up with. In light of this complexity, it can...

The current practice management systems in hospitals and clinics deploy technology and tools to automate workflow, reduce costs and provide the best quality of care. Medical leaders are developing tools including patient engagement systems, healthcare reimbursement models, and more to improve quality...

The medical sector varies from other businesses and consists of complex processes from appointment to care delivery. Imagine this; a food service provider gets paid for every order delivered. Similarly, a doctor needs to receive payment for every care service...

Revenue Cycle Management in the U.S healthcare industry has been gaining momentum over the last few years. With the growing popularity mHealth and integrated healthcare systems, providers are concerned about payment delays and denials. The traditional payment and reimbursement system lacked efficiency and...

In today's healthcare scenario, patients are seen as consumers. And if consumers are satisfied and happy with the providers’ services, then practice will flourish. Moreover, providers leverage intuitive tech solutions to engage these patients. Patient Portal in healthcare is a...

There is an urgent need, among the healthcare sector, for an overall organization and establishment of systematic processing and policy adherence. This is the key for healthcare organizations to stay financially stable and enduring. Revenue cycle management, in a nutshell,...

The 30-year old antiquated ICD-9 coding was replaced by ICD-10-CM/PCS to modernize the medical coding pattern and to reflect changes in the current advanced healthcare practices that expand the capacity of the healthcare industry. The new version of medical codes...