Medical Billing Blogs

  Integrated Electronic Health Record (EHR) systems for billing are comprehensive digital solutions that   streamline the medical billing process . They automate billing and coding tasks, allowing healthcare providers to submit bills electronically to patients and insurance companies. These systems ensure that billing information is accurate and up-to-date, leading to timely reimbursements. Therefore, these systems enhance the overall efficiency of healthcare practices by integrating patient records and billing functions. Let’s have a look at how it improves practice efficiency: Role of Integrated EHR Systems for Billing 1. Automation of Billing and Coding Integrated EHR systems automate the billing and coding processes. This automation minimizes human errors that can occur with manual entries. For instance, Kareo is a cloud-based software that automates claim submissions and insurance verifications. By reducing the time spent on these tasks, healthcare providers can focus mor...

  Prior authorization (PA) is a key process in the healthcare system. It involves getting approval from a health insurance company before certain treatments, medications, or procedures can be provided to patients. Over the years, reliance on prior authorization has grown significantly. According to a 2023 survey by the  American Medical Association (AMA),  86% of physicians reported an increase in prior authorization requirements in the past five years. This rise reflects the growing complexity of healthcare services and the need to ensure that treatments are medically necessary and cost-effective. Accurate prior authorization helps prevent unnecessary costs and ensures the correct use of healthcare resources. However, managing it effectively can be challenging for providers. Let’s have a look at the importance of accurate prior authorization in 2024: Impact of Prior Authorization in 2024 In 2024, the importance of prior authorization in healthcare has grown significantly...

  Credentialing is a critical process in healthcare, allowing providers to become in-network with insurance companies and ensuring patients can utilize their health insurance benefits. For group practices, transitioning to private practice adds an extra layer of complexity, as providers must complete individual credentialing while developing their practice. According to a 2019 report from the Council for Affordable Quality Healthcare (CAQH), the average cost to complete credentialing for each healthcare provider is about $1,000 to $3,000, and delays in credentialing can impact revenue streams significantly.  Insurance credentialing  ensures that healthcare professionals meet the necessary standards of education, licensing, and professional history to be accepted by insurance networks, essential for reimbursement. Let’s have a look at how insurance credentialing can be done: Why Credentialing is Crucial During Transition to Private Practice? Transitioning from a group prac...

  Medical billing is a crucial aspect of healthcare management, ensuring that healthcare providers are reimbursed for their services. However, internal medicine billing comes with unique challenges that distinguish it from other medical billing forms. Internists treat a wide variety of severe and chronic conditions, and the complexity of their services creates specific billing requirements. This blog explores the hidden complexities of internal medicine billing and the differences between internal medicine billing and other types of billing, as well as provides best practices to optimize claims for better revenue performance. Difference Between Internal Medicine Billing and Other Billing Internal medicine billing differs from other medical specialties in various ways: Variety of Services : Internists provide comprehensive care that often involves diagnosing and managing multiple chronic and acute conditions. Unlike other specialties, which may focus on one particular organ system o...

  On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released its final rules for the Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) for Calendar Year 2024. The new guidelines bring significant updates to substance use disorder (SUD) treatment, focusing on expanding access to services, addressing reimbursement rates, and incorporating new billing codes. These changes aim to improve the quality of care for Medicare beneficiaries with substance use disorders and address the ongoing opioid and mental health crises in the U.S. Let’s have a look at the latest CMS guidelines for SUD billing: CMS Guidelines for Substance Use Disorder Billing 1. Expanded Coverage for Mental Health Counselors and Marriage and Family Therapists: Starting January 1, 2024, mental health counselors (including addiction counselors) and marriage and family therapists can enroll in Medicare to treat beneficiaries with mental health conditions and substance us...

  The   Skilled Nursing Facility (SNF) Consolidated Billing (CB)   system plays a crucial role in managing Medicare payments for services provided to patients in SNFs. This system bundles the costs of various services, including medical treatments, diagnostic procedures, and therapies, into one single bill, ensuring consistency and preventing billing overlaps. Over time, these billing codes undergo revisions to ensure alignment with healthcare advancements and service delivery improvements. This article focuses on the key changes in SNF consolidated billing codes, emphasizing updates, exclusions, and newly added codes for 2024. Understanding the Scope of SNF Consolidated Billing SNF consolidated billing Includes a broad spectrum of services, from physician services and dialysis-related treatments to chemotherapy drugs and customized prosthetic devices. These services are bundled and managed under Medicare Part A, with specific services excluded based on regulations. The b...

  Undoubtedly, hospital readmissions are costly for both healthcare providers and patients. However, many readmissions can be avoided through better care coordination, patient education, and discharge planning. To address this, the Centers for Medicare and Medicaid Services (CMS) introduced the   Hospital Readmissions Reduction Program (HRRP) . Under this program, hospitals with high readmission rates face penalties, impacting their revenues. This has led many hospitals to adopt strategies to reduce readmissions and avoid penalties. Impact of Readmissions on Providers When patients are readmitted to the hospital within 30 days of discharge, it often signals a breakdown in care or communication. Although some readmissions are unavoidable, many result from inadequate follow-up, poor discharge instructions, or patient confusion over medications. In fact, high readmission rates can lead to significant financial penalties for healthcare providers under HRRP. The penalties can be as...

  Value-based care (VBC) models are changing the healthcare industry across various specialties, including mental health. This shift from the traditional fee-for-service system, prioritizing the quantity of care delivered, moves toward a model emphasizing quality, patient outcomes, and cost efficiency. In fact, adopting VBC for mental health providers requires restructuring not just how care is delivered but also how billing is handled. Here, we’ll explore the fundamentals of value-based care, its benefits, and its impact on mental health billing. Additionally, we’ll look at how outsourcing companies like  24/7 Medical Billing Services  can assist mental health providers in dealing with this transformation. Understanding Value-Based Care Models At its core, value-based care focuses on improving patient outcomes while reducing healthcare costs. Unlike fee-for-service models, where providers are reimbursed based on the number of services or procedures they perform, VBC ties...