In medical billing, not all payment adjustments are the same, especially when it comes to refunds and recoupments. These two terms are often confused, but they mean very different things. Knowing the difference can help healthcare providers avoid mistakes, stay compliant with rules, and build trust with patients and insurance companies. In this blog, we’ll […]
CPT codes, or Current Procedural Terminology codes, are used in mental health billing to describe the services that healthcare providers give to their patients. These codes help ensure that mental health professionals receive accurate payment and that insurance companies understand the type of care provided. In this blog, we’ll take a closer look at the
Artificial Intelligence (AI) is changing the way healthcare works. It’s helping doctors and nurses provide better care that is faster, more accurate, and more focused on the patient. One exciting new tool leading this change is ambient listening. What Is Ambient Listening in Healthcare? This technology listens to and understands conversations between doctors and patients
Dementia is a condition that slowly damages the brain, making it harder for people to remember things, think, control their behavior, and do everyday tasks. As more people live longer, dementia is becoming more common and is now a major health concern around the world. To give the right care and get proper payment from
The shift from fee-for-service to value-based care is transforming how healthcare is delivered and how providers are compensated. The Merit-based Incentive Payment System (MIPS) is at the center of this change. It was designed by the Centers for Medicare & Medicaid Services (CMS) to reward high-quality, low-cost care. As a healthcare provider, it’s essential to
Accurate documentation is the foundation of effective and compliant medical billing. It not only ensures timely and correct reimbursement but also promotes transparency in healthcare operations. One of the important aspects of EOR in medical billing is the Explanation of Review. Typically issued by workers’ compensation and auto insurance carriers, the EOR explains how a
Getting paid isn’t the only reason for accurate medical billing; it’s also important for keeping the healthcare system working efficiently for both patients and providers. The circumstances can get confusing quickly when a lot of people have more than one insurance plan. That is where Coordination of Benefits (COB) comes in. COB lets insurance companies
Weight loss counseling is more than a supportive conversation; it’s a vital component of preventive healthcare. With over 41.9% of U.S. adults classified as obese (CDC, 2023), the need for structured guidance has never been greater. Obesity significantly increases the risk of chronic conditions such as type 2 diabetes (risk increased by up to 7
A medical coding audit helps ensure your documentation and codes are accurate, compliant, and optimized for reimbursement. Coding errors are somehow costly, leading to 80% of medical bills containing mistakes, and claim denial rates can reach 20% for some providers. Regular audits reduce denials, improve compliance, and strengthen your revenue cycle. Whether handled internally or
As healthcare costs rise and insurance plans become more complex, self-pay in medical billing is becoming increasingly common. More than 30 million Americans remain uninsured, and nearly 43% of insured adults are underinsured due to high deductibles and out-of-pocket expenses (Commonwealth Fund, 2023). Because of this, a lot of people are paying for their medical
Ever received a claim denial and wondered what went wrong? Denial codes are the key to unlocking that answer. These standardized codes are based on the Claim Adjustment Reason Codes (CARC) system, explaining why a claim wasn’t reimbursed and how you can fix it. One important code to understand is Denial Code PR 272, which
Did you know that over 160 million patients visit urgent care centers in the U.S. each year? It’s no surprise they offer fast, affordable care when you need it most. Urgent care visits can cost 30–50% less than a trip to the ER, making them the go-to choice for non-emergency health issues. But while patients
Laboratory Revenue Cycle Management (RCM) is the backbone of a lab’s financial health. It covers everything from patient registration to the final payment. When done correctly, it ensures that services are billed accurately and reimbursements are received in a timely manner. However, with rising complexities, tighter regulations, and changing payer demands, even the most efficient
Medical billing is more than just paperwork; it’s the engine that drives healthcare revenue. At its core lies coding, which translates patient care into standardised formats for insurance claims and reimbursement. But when codes don’t match the complexity of services provided, it can quietly cost providers thousands. This issue is known as downcoding. A standard
Ophthalmology medical billing isn’t just complex, it’s a constant balancing act of detailed coding, procedure-specific modifiers, and ever-changing reimbursement rules. One small mistake can mean delayed payments or lost revenue. That’s why, in 2025, more ophthalmology practices are choosing to outsource their billing to specialized experts. It’s not just about reducing errors. It’s about freeing
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