Revenue Cycle Management Healthcare

  Did you know? The US healthcare system loses an estimated $935 million every week due to medical billing errors, as reported by Gitnux . These errors, although seemingly small, have a substantial financial impact on medical practices within the healthcare industry. From coding mistakes to incomplete patient information, billing errors can disrupt cash flow and create headaches for both providers and patients. In this blog, we'll explore 10 common billing errors that may be draining your healthcare practice's finances and provide tips on how to avoid them. Categorized data and patient information mismatches cause 22% of medical billing errors. 10 Common Billing Errors to Avoid Billing errors in the medical field can occur due to various factors. The 10 most common billing errors to avoid safeguarding your financial health are; 1. Incorrect Patient Information Billing errors often occur due to incorrectly entering patient information, such as misspelled names or inaccurate insu...

DME billing refers to billing for Durable Medical Equipment (DME) such as wheelchairs, hospital beds, and other medical devices. These bills are usually sent to third-party payers, such as insurance companies or Medicaid , for reimbursement. DME coding refers to the service of providing diagnostic medical equipment codes for use in electronic medical records, billing, and reimbursement purposes. These codes describe the type of diagnostic medical equipment used during medical procedures. The codes provide information on the type of equipment used, its functionality, and its cost. QWay’s DME Billing Process 1. Confirming Patient Eligibility We start by verifying if the patient is eligible for DME coverage. This involves checking their insurance, ensuring they meet medical necessity criteria, and getting any necessary pre-authorization or referral. 2. Prescription and Documentation Once eligibility is confirmed, we collect a valid prescription from a licensed healthcare provider. The ...

Understanding HCC Coding Accurate coding?!!! Yes. It is crucial not only for proper reimbursement but also for ensuring quality care delivery. Hierarchical Condition Categories (HCC) coding and risk adjustment play pivotal roles in this process, particularly in managed care settings like Medicare   Advantage . This comprehensive guide aims to demystify HCC coding and risk adjustment, providing insights and strategies for mastering these essential components of modern healthcare coding. HCC coding is a system used by Medicare Advantage plans to adjust payments based on the health status of enrolled beneficiaries. The coding process involves assigning specific diagnostic codes, primarily drawn from ICD-10 -CM, to reflect the severity of a patient's health conditions and predict their healthcare costs for the upcoming year. Each diagnosed condition corresponds to a particular HCC code, which carries a weight reflecting its expected impact on healthcare spending. Key Elements ...

  Did you know that about 35% of denied claims result from inaccurate patient identification? This small error ends up costing the average hospital $2.5 million and the entire U.S. healthcare system over $6.7 billion every year, as per a survey conducted by Black Book Research . Not only do these errors lead to claim denials, but they also trigger delays in getting reimbursed. It's evident that accurate patient demographics are a critical step in ensuring smooth revenue cycle management (RCM). Moreover, understanding what patient demographics encompass and their significance is essential. In this blog, we will explore what patient demographics mean, its components, and its importance in the medical billing and coding process.  What is Patient Demographic? The patient demographic refers to the personal and medical information used in RCM to identify patients and determine their eligibility for insurance coverage or payment for medical services. This information includes the pa...

Telehealth has revolutionized the way healthcare is delivered, providing convenient access to medical services remotely. With the increasing popularity of telehealth, understanding the associated Current Procedural Terminology (CPT) codes is essential for healthcare providers and billing professionals. This comprehensive guide aims to demystify telehealth CPT codes, providing insights into the key codes used for billing and reimbursement in remote care settings. Telehealth CPT codes are used in billing for virtual healthcare services provided via audio, video, or other electronic communication methods. These codes enable healthcare providers to accurately document and bill for telehealth encounters, ensuring proper reimbursement for remote care services. The following are some common telehealth CPT codes and their descriptions; Telehealth CPT Codes Cheat Sheet 1. 99441-99443: These codes are used to bill for brief online digital evaluation and management services. ·  ...