Value-Based Care Payment Models in Healthcare
The healthcare system is experiencing a major transformation. Traditionally, providers were paid under a fee-for-service model, meaning doctors and hospitals earned money for every test, visit, or procedure they performed. While this system raises the service volume, it often leads to higher prices without essential enhancing patient health. Today, the concentration is shifting toward the […]
ICD-10 Codes for Skin Tags: Billable and Non-Billable
Skin tags are common, benign skin growths that look like small, soft pieces of skin attached by a thin stalk. Although they are medically harmless in most cases, skin tags can become irritated, inflamed, or bleed due to friction from clothing, jewelry, or body movement. In such cases, removal can be considered clinically rather than […]
How Often Should Patients Receive a Billing Statement?
Timely payment collection is important for sustaining financially healthier healthcare practices. However, repeatedly asking patients for payment can feel uneasy and might stress patients’ relationships. On the other hand, sending billing statements too infrequently can result in delayed or lost revenue. The solution lies in finding the right balance – clear communication delivered at the […]
Physician Credentialing Issues to Avoid in Healthcare
Physician credentialing is one of the most critical processes in the healthcare system. Before a provider can provide care, bill insurance, or join payer networks, their education, licenses, experience, and professional history must be verified. When credentialing is performed perfectly, it protects patients, helps with compliance, and confirms uninterrupted revenue. When handled poorly, it leads […]
Common Reasons Why Surgery Claims Are Rejected and How to Avoid Them
Managing a surgical practice needs more than medical excellence – it demands accuracy in documentation, compliance with payer regulations, and efficient medical billing services. From cardiac surgeries and organ transplants to reconstructive and deep tissue procedures, surgeons regularly handle complex conditions. Many surgeons struggle to balance patient care with administrative responsibilities. Without expert billing support, […]
Clean Claim Submission Process in Medical Billing
Understanding the complexities of medical billing is important for healthcare providers who desire to confirm timely and accurate repayment. One of the most critical aspects of this process is the Clean Claim Submission Process in Medical Billing in the USA. A single error in claim submission can cause delays, claim denials, and even lost revenue. […]
How to Bill DME Claims to Medicare: A Guide for DME Providers
Billing Medicare for Durable Medical Equipment (DME) is one of the most regulated areas of medical billing. DME providers must adhere to strict Medicare instructions related to criteria, documentation, coding, claim submission, and appeals. Even a small mistake can outcome in claim denials, delayed payments, or lost revenue. This direction, How to Bill DME Claims […]
How to Use Incident-To Billing in Mental Health Care the Right Way
Medicare billing is notoriously complicated, especially for psychiatry and behavioral health providers. One of the most misunderstood regions is incident billing – a policy most medicals have heard of, but some completely grasp. When applied correctly, incident-to billing can potentially increase reimbursement, enhance patient flow, and support mental health practices to operate more efficiently. This […]
How to Bill Outpatient Observation Services Correctly
Knowing the details about how to Bill Outpatient Observation Services Correctly in the USA is essential for hospitals, billing teams, and revenue cycle professionals. Observation billing is closely regulated by CMS and needs concise documentation, rectifies coding process, and a strong grasp of Medicare’s Outpatient Prospective Payment System (OPPS). Mistakes can easily lead to denials […]
Out Of Network Medical Billing Guide
When it comes to Medical Billing Services, the terms in-network and out-of-network can feel confusing – but their meaning is actually straightforward. In-network providers have contracts with insurance companies, agreeing to offer facilities at negotiated, discounted rates. Out-of-Network providers, on the other hand, do not have such contracts. Because no agreement exists, these providers might […]