Medical Billing Blogs

  The healthcare industry is continuously evolving, and one area witnessing significant transformation is Revenue Cycle Management (RCM). The integration of artificial intelligence (AI) and automated workflows is poised to revolutionize RCM by enhancing operational efficiency, reducing costs, and improving financial outcomes for healthcare providers. As third-party payer denials and collection costs rise, providers are increasingly turning to AI-driven solutions to streamline their revenue cycle processes. Revenue Cycle Management Integrating AI Solutions Currently, 46% of hospitals and health systems are using AI in their RCM operations, as per a recent  HFMA  Pulse Survey. This adoption is part of a broader trend towards automation in healthcare, with 74% of hospitals implementing revenue-cycle automation, including RPA and AI. While AI in RCM is focused on specific functions now, its potential for broader integration is significant. The Potential of AI to Innovate and ...

  Risk-based payment models, also known as budget-based contracting, are evolving in the healthcare industry as an alternative to traditional fee-for-service models. These models aim to control healthcare costs and improve care quality by holding providers financially accountable for patient outcomes. Risk-based payment models  are structured around an estimated cost of treating a specific condition or patient population. These estimates are based on sophisticated actuarial models and include direct and indirect practice expenses as well as a margin. In fact, there are various risk-based payment models for healthcare providers, such as: Understanding Risk-Based Payment Models Risk-based payment models are designed to align the financial incentives of healthcare providers with the goal of delivering value rather than volume. These models aim to improve patient outcomes, enhance care quality, and reduce unnecessary healthcare spending. Here are the key types of risk-based paymen...

  Previously linked mainly to cryptocurrencies, blockchain technology is now making waves in the healthcare industry. This revolutionary technology, recognized for its transparency, security, and decentralization, offers a promising solution to longstanding challenges in medical billing and changing the dynamics of financial transactions in healthcare. Medical billing  involves the complex process of submitting and following up on claims with health insurance companies to receive payment for services provided by healthcare providers. This process is often plagued by issues such as billing errors, fraud, and lengthy payment cycles. By leveraging blockchain technology, healthcare providers can streamline billing processes, enhance data security, and improve overall efficiency. Did you know? According to a report by BIS Research, the global market for  blockchain in healthcare  is expected to reach $5.61 billion by 2025, growing at a compound annual growth rate (CAGR) o...

  Remote Therapeutic Monitoring (RTM) and Remote Patient Monitoring (RPM) have significantly transformed the healthcare industry, particularly following the expansion of reimbursement policies. As a result, there is a need to understand the nuances of these technologies and their implications for medical billing and coding, which is essential for care delivery organizations. Let’s have a look at such a relationship: 1. Expansion of Reimbursement Policies CMS’s  expansion of reimbursement policies has driven the increased utilization of RPM and RTM. Therefore, the key policy changes include: Billing Flexibility : Providers can now  bill for RPM or RTM  alongside other care management services for the same patient, such as Chronic Care Management (CCM) and Transitional Care Management (TCM). Inclusion of RHCs and FQHCs : Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) can bill separately for RPM and RTM services. These changes offer healthcar...

  The healthcare industry is transforming significantly from traditional fee-for-service (FFS) payments to   value-based reimbursement (VBR) models . This shift emphasizes quality of care over the quantity of services provided, aiming to enhance patient outcomes while controlling costs. As this transition accelerates, healthcare providers must adopt new billing strategies to maximize revenue and ensure high-quality care. Overview of VBR Models Value-based reimbursement models in healthcare focus on compensating providers based on the quality and efficiency of care delivered rather than the volume of services rendered. These models incentivize healthcare providers to improve patient health outcomes, enhance care coordination, and reduce unnecessary medical spending. The ultimate goal is to create a healthcare system that rewards value and outcomes rather than sheer service volume. Transitions of VBR Models in Healthcare As the healthcare industry transitions from  fee-for-...

  The   Outcome and Assessment Information Set (OASIS)   has been integral to home health care since its inception in 1999. It serves as a critical tool for assessing patient care quality and outcomes. OASIS collects information on around 100 items related to a home care recipient, including demographic data, functional status, clinical status, and service needs. These assessments are essential for Medicare and Medicaid reimbursement, quality measurement, and care planning. As of January 1, 2023, the latest iteration, OASIS-E, introduces significant changes designed to improve alignment across post-acute care settings, enhance data accuracy, and ultimately elevate patient care standards. Let’s have a deep analysis of the same: Significant Changes from OASIS-D1 to OASIS-E The transition from OASIS-D1 to OASIS-E brings several critical updates. One of the most significant changes is the inclusion of social determinants of health. Recognizing the impact of socioeconomic fact...

  Choosing the right   credentialing service provider   is a difficult decision for healthcare practices. Credentialing ensures that healthcare providers meet the necessary qualifications and standards to deliver care. With the increasing complexity of healthcare regulations, it’s essential to select a service provider that can manage the process efficiently. Here are five key considerations to keep in mind: 1. Experience and Expertise When evaluating credentialing service providers, experience and expertise should be at the top of your list. An experienced provider will be well-versed in the nuances of different healthcare specialties and state regulations. They can navigate the complexities of the credentialing process more effectively, reducing the risk of delays or errors. Look for providers with a proven track record and positive reviews from other healthcare organizations. Fact: According to a survey by the American Medical Association (AMA), 83% of medical practice...

  In recent years, the importance of nutrition in maintaining health and managing chronic diseases has gained significant recognition. Nutrition therapy, often provided by registered dietitians, can be crucial in managing conditions like diabetes, heart disease, and obesity. However, navigating insurance coverage for these services can be complex. Here you understand how insurance coverage for nutrition therapy works and what you need to know about Nutrition as Therapy Billing. What is Nutrition Therapy? Nutrition therapy, also known as  Medical Nutrition Therapy (MNT) , involves using specific nutrition services to treat medical conditions. Registered dietitians and nutritionists provide these services, which include personalized dietary plans, nutrition education, and ongoing support to help individuals manage their health conditions effectively. Insurance Coverage for Nutrition Therapy Insurance coverage for nutrition therapy varies widely depending on the insurance provide...