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 […]
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 […]
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 […]
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 […]
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. […]
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 […]
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) […]
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. […]
Fraud in medical billing involves a broader range of illegal practices and may occur in different settings. At basic levels, medical billing fraud involves a healthcare practitioner who bills for services they did not provide. Furthermore, billing fraud is also one of the most common forms of Medicare fraud. However, improper billing practices can take […]
Medical billing credentialing increases the credibility of healthcare professionals. The process involves a systematic evaluation of a healthcare provider’s qualifications and practices, ensuring the delivery of quality healthcare services to patients. Moreover, it plays a key role in improving the efficiency of medical billing services, which facilitates timely reimbursements. The primary goal is to validate the […]
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