Medical Billing Blogs

  Background : A Mental Health Provider in Ohio was struggling to manage its billing and revenue cycle processes. The provider faced challenges such as delayed payments, lost revenue due to claim denials, and inefficiencies in the billing process. The provider had tried several solutions to address these challenges, including hiring additional staff and implementing new software. However, none of these solutions proved to be effective in improving the provider’s financial health. The Mental Health Provider then decided to partner with 24/7 Medical Billing Services,  a leading medical billing and coding company   in the United States, to address these challenges. Solution : 24/7 Medical Billing Services conducted a detailed analysis of the Mental Health Provider’s billing and revenue cycle management processes to identify areas of improvement. The team found that the provider was facing the following specific challenges: Inefficient Billing Process : The provider’s billing...

Typically, hospital and professional coding begin when an obstetrician-gynecologist records information on patient services. When that information is sent out as a charge capture, it is assigned a OB/GYN billing code. It isn’t easy to navigate this process, especially since everything from hospital room to various processes and tests must be billed for reimbursement. This necessitates highly qualified professionals with experience securing revenue opportunities while protecting healthcare organizations from compliance risk and financial penalties. Challenges with OB/GYN Billing Processes: As the revenue cycle progresses, information is passed from one department to the next. Hospitals risk losing revenue integrity if any miscommunication or details are included. Insurance companies already under financial pressure deny a significant percentage of claims based on mismatched procedures and ICD codes. Many coding errors occur because coding professionals need more detailed physician docum...

Behavioral health billing presents different challenges than other types of medical billing. The approach to therapy, the length of the session, and the patient’s willingness to contribute make standardizing treatment and, thus, billing far more complex. Furthermore, how insurance companies view behavioral health is noticeably different from how they view more traditional medical practices. Insurance companies can dictate how long treatments can last and how many sessions can be held per day, making it difficult for behavioral health providers to balance effective billing with adequate patient care. Furthermore, the pre-authorization requirement has increased the difficulty and complexity of behavioral health billing. It’s common in behavioral health to have a small group or solo practice with confined administrative support for billing and other office duties. Some providers will even try to do their own billing, but this will quickly become overwhelming and cause time management issu...

  Clinical care is becoming more common in pharmacies as more pharmacists seek to provide services other than filling prescriptions. And while providing clinical care can be a game changer, especially for independent pharmacies struggling to compete in a highly competitive industry, getting compensated for those services is both necessary and challenging. New Era Pharmacies, or what we consider to be the pharmacy of the future, understand how to be compensated not only for the prescriptions they dispense but also for the clinical care services they provide to patients. Even the most knowledgeable and experienced independent pharmacists must begin somewhere, and getting it right necessitates the right tools, knowledge, and resources to ensure complete and timely medical reimbursement. This article will helps to Streamlining Pharmacy Billing Processes in Physician-Based Clinics. Tips to Streamline Pharmacy Billing Processes: Despite having some of the best healthcare in the world, Am...

Today’s radiology practices face significant financial challenges. Over the last decade, compliance rules have changed, physician reimbursements have fallen, high-deductible health plans have become common, and the costs of employing staff to provide services, such as Radiology and Imaging Centers Billing and audits, have risen. All of these factors have reduced the operating margins of practices. In other words, it can be said that radiology practices face numerous reimbursement challenges – adding trouble to their survival. But fortunately, such practices can improve inefficiencies in various ways. As a result, practices should consider novel approaches to managing these dynamics. Let’s have a deep dive into a few of such ways:  1.  Leverage Technology for Collections After insurance payments, there will inevitably be uncollected balances, and the practice will have to contact the patient for payment. Accounts receivable follow-up activity can be scheduled and executed ...

When managing healthcare practices revenue cycle, timely submission of medical bills and insurance claims is critical. Physicians and doctors’ busy schedules frequently prevent them from promptly completing medical billing and coding tasks. As a result, outsourcing medical billing and coding companies assist healthcare providers in obtaining timely and error-free results. In fact, such established outsourcing companies provide efficient medical billing and coding services to direct healthcare providers in claiming reimbursement within the specified time frame, thereby increasing their practice’s revenue. Let’s see the impact of medical billing outsourcing on the revenue of your practice in 2023 in-depth: Finding Overlooked Revenue Opportunities Medical practitioners are frequently so busy that they cannot devote enough time required to maximize revenue opportunities. Professional medical billers can step in and calibrate a practice’s revenue systems for increased effectiveness. Many fa...

 Patient eligibility verification is a crucial step in the medical billing process. It ensures that the patient is covered by their insurance and that the provider will be reimbursed for the services rendered. However, the process can be time-consuming and prone to errors. This is why it is important to improve the patient eligibility verification process in order to ensure the smooth functioning of the healthcare system. In this blog, we will discuss five ways to improve the patient eligibility verification process. So let’s get straight into it! Automate the process: One of the biggest challenges in patient eligibility verification is the manual process of contacting insurance companies and waiting for a response. This takes a great amount of time and effort. By automating the process, you can reduce the time and effort required to verify patient eligibility. Electronic verification tools can quickly check the patient’s coverage and provide real-time updates, maki...

  According to recent CERT data, the DME billing space has a 39.9% improper payment rate, draining $3.2 billion from the Medicare Trust Fund each year. This error rate is three times higher than the current national Medicare wrong payment rate of 12.1%. What is the simplest way to avoid this industry’s baggage and ensure you receive maximum reimbursements every time? Providing clean paperwork and documentation is critical to avoid mistakes and reduce improper payment. To ensure error-free submissions, the medical billing team must avoid common causes of improper payments, such as inadequate documentation, insufficient documentation (required to make informed decisions), or incorrect coding. Examine the following practical methods for lowering improper payment rates in DME billing . Ensure Complete Documentation Documentation is essential for accurate DME billing; good documentation is strategic. A detailed narrative is provided by accurate and complete patient documentation and usi...

  Many people perceive January 1 as a good time to set goals and broaden their knowledge or skill set. Some may learn a new language, while others may read more novels throughout the year. One New Year’s resolution for speech-language pathologists might be to brush up on Speech Language Pathology (SLP) Billing best practices. After all, with Medicare’s recent reduction in reimbursement for therapy services, making every claim count in the new year will be more critical than ever. With that in mind, here are common questions about  Insurance billing for outpatient services  that every SLP should be aware of: Do SLPs work with patients or clients? SLPs work with clients/patients of all ages in their homes or outpatient settings like speech and hearing clinics or doctors’ offices. SLPs who provide home care services may work for home health care agencies, early intervention programs, or in private practice. Can a speech-language pathologist bill Medicare directly? Speech-lan...