Medical Billing Reports help a physician to understand the financial health and the business side of the practice. The reports clearly show the different revenue cycle metrics, which indicate the areas of concern needing corrective action and the areas where revenue can be increased. Whether revenue comes from payors or patients, medical reports help a practice stay profitable while delivering excellent patient care.

Listed below are four impactful medical billing reports that will help a physician monitor the practice’s financial health and not leave money on the table. (more…)

What is pre-authorization?

Pre-authorization is the procedure of obtaining prior approval from payors before medical services are rendered to patients. It indicates that the payor confirms the medical necessity of the service, treatment plan, prescription drug, or durable medical equipment being offered/prescribed. (more…)

What is Accounts Receivable in Healthcare RCM?

Managing Accounts Receivable (AR) and a healthy cash flow is a major challenge for every healthcare professional and facility. In the healthcare industry, AR represents the amount that is due from insurance companies and patients.

To understand the AR status of a practice, “Days in AR “is computed, which is the average number of days it takes to collect payments that are due to the practice. The AR is then classified into buckets such as 0-30 days, 31-60 days, 61-90 days and so on separately for patients and payors. The aging AR bucket data indicates the performance of the billing department. (more…)

Podiatry as a specialty is quite different and coding professionals need to be aware of the complexities in this specialty to reduce denial of claims. Medicare and commercial payors insist on medical necessity for foot care and thus, coding in podiatry specialty and revenue cycle management (RCM) is an area where confusion reigns. Most of the payors will reimburse if there is a foot condition but not for its preventive care. Hence podiatry coding procedures need to be dealt with carefully. (more…)

Denial Management is vital to your practice

Denial of claims is a source of stress and a drain on the revenues of a practice. Therefore, denial management is a vital component of the Revenue Cycle Management and consists of four stages, namely, Identifying, Managing, Monitoring and Preventing claim denials.

Medical professionals submit millions of claims every day to payors. Most claims are reimbursed fully by payors. As per the AMA reports, claims denied on the first submission amount to 1.38% to 5.07% of the total claims. Even the best-performing practices see a denial rate of 5%. Denied claims represent delayed or lost revenue to a practice. (more…)

What is Revenue Cycle Management?

Healthcare professionals train for years to treat patients and save lives while learning next to nothing about the business side of practices. Providers need to develop successful practice management processes to stay financially healthy. A medical facility’s entire financial process is termed Healthcare Revenue Cycle Management (RCM) and it covers management and collection of revenue from healthcare service to patients.

The healthcare revenue cycle starts when a patient makes his/her appointment to seek medical services from a healthcare provider. The process ends when claims are reimbursed and patient payments have been collected.  (more…)