Discover how Clinical Documentation Improvement (CDI) revolutionizes healthcare data management, enhancing patient care, data integrity, and financial outcomes. Unleash the potential of CDI to optimize your healthcare organization's data and drive better outcomes.

DRG-based reimbursement (Diagnosis-Related Group), plays a pivotal role in determining the payment healthcare facilities receive for treating Medicare patients. While the primary diagnosis code identifies the main reason for hospitalization, the significance of secondary DX codes in the DRG-based reimbursement process cannot be overstated.

The Florida Legislature recently amended the Florida Electronic Health Records Exchange Act to prohibit certain healthcare providers utilizing certified electronic health record technologies from storing qualified electronic health records outside of the United States, its territories, or Canada.

Healthcare administrative talent will be in short supply for many years, and medical billing and coding offer lucrative career options. This blog discusses the importance of medical coding, the career opportunities it provides, and how medical coding will play a critical role in defining the quality of care.

Our client, a mid-sized hospital group, faced challenges getting reimbursed for ED visits. Sub-optimal client documentation processes led to delayed payments and reduced reimbursements. Our initial analysis revealed that delayed billing was the root cause. We conducted an exhaustive internal audit of 30 physicians working across two facilities in Washington and Florida. In this case study, we highlight how improved clinical documentation and coding quality lead to increased reimbursements.

Claim denials, a chief cause of revenue loss to healthcare practices, are rising across payer types. A primary source of denials is on account of coding-related denials. A comprehensive and focused denial management and appeals strategy will help reduce this revenue loss.

When clinicians handle the billing themselves, they spend considerable time, money, and effort on administrative tasks rather than doing what they do best-providing outstanding medical care. Trained and specialized Radiology Billing specialists understand the changing rules and regulations for specialties and the nuances of payer-specific guidelines in their respective regions.

Outsourcing and offshoring the Medical Coding process can give you access to certified coders, reduce denials, improve reimbursements, and plug revenue leakage. Healthcare providers and revenue cycle aggregators must choose the right service providers to improve the coding quality and achieve market-leading outcomes.

The majority of patients require customer support provided by a real person; robots and applications are often disappointing or infuriating. The impact on the healthcare RCM (Revenue Cycle Management) is one of the things that is not expected to reverse any time soon or ever. Click here to learn more on changes in the healthcare system which have posed the biggest challenges to RCM.

Reducing reimbursement rates, increasing infrastructure costs, and shifts in payer mix create challenges for radiology practices. Download this guide on Radiology Best Practices to learn more.

With COVID-19 vaccinations now being administered across the United States, we have compiled these medical coding guidelines to account for the treatment and vaccinations for the novel Coronavirus.

Ob/GYN billing & coding can be challenging to most billers & coders due to the global claims, widely varying coverage terms, and multiple tests performed at numerous facilities. Apart from this, many OB/GYN practitioners lack the billing support provided to large hospitals. Learn more about the challenges in Ob/Gyn coding and best practices followed by our coding experts.

Emergency departments are fast-paced environments where care is delivered quickly depending on the patient's condition's criticality. Further, ED does not deal with one specialty per se. ED provides Medical services across specialties. It also requires close coordination of services from when a patient enters an ambulance or an ED facility to discharge, working with multiple clinical practitioners. Learn more about ED coding best practices in this guide from Medical Billing Wholesalers..

Many Primary Care Physicians lose money because of lack of understanding of payer specific claims submission guidelines. Educating physicians on their documentation responsibilities is an iterative process, that requires an understanding of the reasons for claim denials, ability to nail-down the issues that are causing the denials, determining the corrective actions, and hosting timely sessions between the denials team and the physicians to discuss them.

Bad quality scanning of superbills and lack of adoption of electronic claims submission creates a charge backlog situation and consequently, result in increased denials on account to timely filing dates not being adhered to. Read this case study about how our structured approach, technical expertise, and revenue cycle rigor combine to create value for our client.

Internal medicine can be defined as the medical specialty dedicated to the diagnosis and medical treatment of adults. With so many new codes introduced and trickier coding, claim denials have increased for many internal medicine practices. Keep your coding team updated with the latest best practices in internal medicine coding with this guide from Medical Billing Wholesalers.

Standardized billing and coding practices for Spinal Cord Stimulator (SCS) Procedure Code 63650 reduce medical necessity denials and help collect 281 claims valued over $ 300K in 2 years. The Customer saw over 36% improvement in Collections, as much as 75% reduction in old AR over 61 days, and reduction of denied SCS claims from 68 to 8 over a 7 month period.

Podiatry billing can be complicated in many ways, beginning the need to determine and prove the medical necessity of the treatment, to the coding nuances. It demands meticulous use of modifiers and an understanding of coding for inclusive procedures. In this guide, Medical Billing Wholesalers bring you the guidelines & best practices to be followed to increase collections of your Podiatry practice.

The unique CPT code will be used to report laboratory testing services that diagnose the presence of the novel coronavirus. This will help provide the data for analytics as testing to identify the incidence of the virus continues across the United States.

Medical Coding is a key element of the revenue cycle and drives the communication between healthcare providers and insurers. In this article, we talk about the importance of medical coding and the career opportunities the field presents