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Medical billing is the process of submitting claims and following up on them with health insurance companies, both federal and commercial, to receive reimbursement for services rendered by a healthcare provider. Medical billing thus translates a medical service into a billing claim. A knowledgeable biller can optimize revenue performance for the practice.

Rules and regulations governing the healthcare industry are updated constantly. The code sets also undergo revisions regularly. Physicians have to devote a large part of their time to overseeing billing and follow-up. This eats into the time needed for quality patient care leading to stress and frustration.

To overcome this scenario, physicians are forced to find a solution to reduce their workload and increase the quality of patient care delivery. (more…)


Comprehensive Revenue Cycle Management – Getting Paid on Time

An effective Revenue Cycle Management helps practices to increase efficiency and revenues. It also ensures to cut cost and reduce denials considerably. Revenue Cycle Management is not about just one activity, it is all about managing the entire process from start to finish. In the healthcare setting Revenue Cycle Management begins even prior to a patient’s visit to the facility.

Pre-verification or insurance eligibility verification is the first step in Revenue Cycle Management. All the patients scheduled to visit the provider are verified for eligibility and benefits with their insurance. All authorization and referral requirements are clearly understood and documented. Co-pay, Deductibles and out of pocket expenses are also documented. First step to effective Revenue Cycle Management begins with collecting the patient liabilities immediately during the visit. (more…)


Eligibility Verification is a significant denial management tool

Providers lose thousands of dollars every year when services provided by them are denied as non-covered services by the patients’ medical insurance company. Usually, the providers know about these denials anywhere between 15-30 days after the services were provided. As a result, they end up billing the patient after 30 + days and need to spend more time, money and resources to collect the dues. If they are not successful in getting the money from the patient, it will usually be moved to a collection agency. This non-productive billing process can be elevated by adopting insurance eligibility verification.

It is standard for individuals or employers to change their insurance plans for various reasons. These frequent changes make it essential for the providers to have updated information on patient insurance coverage. Hence eligibility verification process has become a crucial step in quicker reimbursement. It reduces and, in many cases, eliminates denials. Eligibility verification helps to increase provider revenues and weeds out uncollectible. (more…)