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Cardiology is one of the hardest specialties to bill correctly. Between diagnostic testing, interventional procedures, device management, and evaluation and management visits that often happen on the same day, a single cardiology encounter can generate five or six billable events. Miss one modifier or bundle two codes that shouldn't be bundled, and the whole claim comes back. We've reviewed claims for cardiology groups ranging from solo practitioners to multi-physician cardia

Ask ten people on your staff what "revenue cycle management" means, and you'll probably get ten different answers. Some will say it's just medical billing. Others will point to the claims department. A few will shrug and say "isn't that the insurance stuff?" They're not wrong, exactly. They're just describing one piece of something much bigger. Revenue cycle management, or RCM, is the entire financial journey of a patient encounter from the moment someone books an appointment

Most practices don't lose money on athenahealth because the software is broken. They lose money because of small, repeatable habits that never get corrected, a missing modifier here, a charge that never gets entered there, a denial that sits untouched for six weeks. Add those up over a year, and you're looking at tens of thousands of dollars that never should have left the table. I've reviewed enough revenue cycles to know that athenahealth is a capable platform. It has stron

If your practice uses Tebra, you already have a capable billing platform. Yet many providers experience claim denials, delayed reimbursements, and inconsistent cash flow and assume the software is to blame. In reality, reimbursement issues are usually caused by workflow gaps rather than the platform itself. This article explains how to maximize reimbursements while continuing to use Tebra, without the cost and disruption of switching software. Why Switching Software Usually I

A denied claim doesn't just cost you the reimbursement. It costs you the staff time to figure out why it was denied, the time to correct it, the time to resubmit it, and then the wait for a second decision that might land on you again. Multiply that by even a modest denial rate, and you're looking at one of the biggest silent drains on an independent practice's revenue. Industry surveys put the average initial denial rate somewhere between 10% and 15% of submitted claims, and

As a healthcare provider, BillingTips's essential to stay informed about payer policies and updates to ensure you receive timely and accurate reimbursement for your services. The best way to stay informed is by reviewing daily correspondence from payers, including policy updates, claims denials, credentialing status, refunds, appeals outcomes, provider directory data, and demographic data. Policy updates: Payers may make changes to their policies and guidelines, such as new c

One of the first BillingTips's steps to take when following up on accounts receivable is to confirm that the claim has been received by the payer. Most payers have an online portal where you can check the status of your claims, so be sure to utilize this tool. If the claim hasn't been received by the payer, follow up with your billing team to ensure that the claim was submitted correctly. Once you confirm that the claim has been received by the payer, it's important to keep t

As a healthcare provider, it can be frustrating to deal with patients who have outstanding balances that have not been paid despite multiple attempts to collect payment. It is important to understand that collecting outstanding balances is critical to the financial success of your practice. #BillingTips 6: Hire a Collection Agency If a patient has an outstanding balance after receiving three statements, it may be time to consider hiring a collection agency. A collection agenc

If a patient has insurance, they will typically have a deductible and co-pay amounts that must be met before the insurance company will pay for services. Collecting upfront payment for these amounts can help ensure that the patient is aware of their financial responsibility and can help reduce the risk of denied claims due to non-payment. #BillingTips 5: Collect upfront payment for deductibles and co-payments To collect upfront payment for deductibles and co-payments, you can

As a healthcare provider, it is crucial to ensure that your patients have coverage for the services you provide. One way to do this is by reviewing your patients' eligibility and benefits before providing any services. This can help you avoid billing patients for services that are not covered by their insurance, reducing the risk of denied claims and patient dissatisfaction. #BillingTips 4: "Ensuring Patient Coverage: Reviewing EV and Benefits" One tool that can be used to ve

As a medical provider, maximizing reimbursement is essential for maintaining a financially successful practice. One of the most effective ways to maximize reimbursement is by understanding the policies of each payer you work with. Each payer has its own set of rules and guidelines for billing, which can significantly impact your reimbursement rates. By understanding payer policies, you can ensure that you are billing correctly, minimizing denials, and maximizing reimbursement

Medical billing is a crucial part of running a successful medical practice. However, one of the biggest challenges that medical practices face is handling daily EOB denials. When a claim is denied by an insurance company, it means that they will not be paying for the services rendered. Daily denials can lead to a significant loss of revenue, affecting the financial stability of your practice. Therefore, it is essential to learn how to work on daily denials effectively to maxi

For medical practices, financial success is critical to their sustainability and ability to provide quality care to patients. One crucial aspect of achieving this success is managing revenue cycle activities such as billing, coding, and claims management. These activities can be complex and challenging, leading to errors and rejections from payers. Clearinghouse and payer rejections are among the most common challenges that medical practices face in their billing and reimburs