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Steps to Revenue cycle management optimization in Healthcare

Steps to Revenue cycle management optimization in Healthcare

Healthcare revenue cycle management optimization involves unifying healthcare’s clinical and business sides through the coupling of administrative data. The data includes the patient’s name, their insurance provider, and other personal information about the patient’s treatment, in addition to their healthcare history/data. One key component of revenue cycle optimization is hands-on and continuous communication with health insurance providers. Revenue Cycle […]

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What is Credentialing and Enrollment

What is Credentialing and Enrollment? 

Hiring unprofessional healthcare providers or letting them stick around can lead to more legal trouble for provider practices. To avoid this, you must check your providers’ credentials. Also, it is important to ensure everything is upgraded. If you do not check, it can hurt how much money your facility makes. Thus, it can put you […]

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Best Claims Denial Management Strategies in Healthcare

Best Claims Denial Management Strategies in Healthcare

For 2024 – most healthcare practices will likely adopt stronger claims denial management strategies for handling the rising challenges of claim denials. A survey concluded that over 51% of respondents plan to be more aggressive with their claim denial management – while 46% intend to boost their payment collection efforts with the payers. Moreover, some organizations will […]

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Credentialing for independent pharmacies

Credentialing for Independent Pharmacies

Credentialing in healthcare is a thorough process of assessing and establishing healthcare providers’ academic qualifications, licensure, and clinical practice. Pharmacist credentials help ensure that the pharmacists billing to insurance providers and patients are properly reimbursed. However, what is credentialing for pharmacies? And How are credentials for a pharmacist related to certifications and licensure? Let’s discuss all about credentialing for independent […]

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pharmacy billing and reimbursement

Pharmacy Billing and Reimbursement

Both pharmacy billing and reimbursement are vital aspects of the healthcare system. The pharmacy revenue cycle management ensures that pharmacies offer essential medications while maintaining financial viability. Let’s explore the details and complexities of pharmacy billing and reimbursement, detailing the key concepts, challenges, and best practices – all of which can be adopted by pharmacists for managing the pharmacy revenue […]

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Difference Between Medical Billing and Pharmacy Billing

Difference between Medical Billing and Pharmacy Billing

Recently, pharmacists have expanded the scope of their practice and services by incorporating additional clinical aspects into their routines. The pharmacy billing process now also caters to specific aspects of patient care, including: For medical billing and pharmacy billing services to remain sustainable – pharmacists must be able to receive payment for resources and time given to improving patient […]

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What is entity code in medical billing

What is Entity Code in Medical Billing?

An entity code in medical billing helps identify the type of entity billing for treatment services. The entity codes ensure that the correct entity gets the bill of services and that neither Medicare nor Medicaid receives bills for the same services. The healthcare professional, billing partners/offices, or insurance payers can assign an entity code in medical billing. […]

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What is a condition code in medical billing

How is the Condition Code in medical billing defined?

If you happen to be in the medical field – without a doubt, you will be familiar with the condition codes in medical billing. A condition code is an essential part of medical coding and billing processes. However, what is condition code – exactly? And – how can you use them correctly? Importance of a Condition Code in Medical Billing […]

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A Healthcare Providers Guide to Clinical Documentation Improvement

A Healthcare Providers Guide to Clinical Documentation Improvement

Documentation becomes essential for effective patient care when a patient interacts with a healthcare professional. Furthermore, documentation must be timely, precise, consistent, reliable, complete, and clear to accurately reflect the patient’s condition. It needs to be clear and legible to elaborate on the patient’s disease, condition, and the extent of services provided. Here, clinical documentation improvement (CDI) […]

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4 types of medical coding in healthcare

What are 4 types of medical coding in healthcare?

The different types of medical coding bring along a transformation of healthcare diagnosis, procedures, medical billing services, and equipment. The diagnoses and procedural codes are taken from the medical records and documentation. These include the transcriptions of physicians’ notes, laboratory and radiologic lab results, etc. Medical coding takes place each time a patient sees a healthcare provider. […]

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