Outsourced medical billing fees generally range from 4% to 10% of your collections. Some medical billing services, such as ours…
Pain management medical billing faces more regulation than most specialties. Nearly every epidural injection, nerve block, or trigger point injection…
If you’re already outsourcing medical billing services and starting to doubt your current provider, switching companies doesn’t have to mean…
Physical therapy billing is challenging. It’s harder to get right than most specialties because it depends on precise, time-based coding…
Running a small medical practice is a lot. Between seeing patients, managing your team and keeping up with payer regulations,…
The clinical slide of your work is just one half of the equation if you run a small medical practice.…
Chances are, you’ve wondered at some point whether you’re paying the right amount for billing services if you run a…
Revenue codes are the four-digit numbers that you’ll see on institutional claims to identify the department or type of service…
A self-pay patient is someone who pays for medical services out of pocket without using health insurance. No insurance company…
Coordination of Benefits (COB) is the process insurance companies use to determine which health insurance plan pays first and how…
When a payer denies a claim, there’s an appeal process you can use to push back – formally asking someone…
Medical billing compliance is about making sure all your billing operations follow all of the following: – Applicable federal laws…
Charge capture is the process of recording every medical service a patient receives so you can submit it for reimbursement…
Medical coding guidelines are standardized rules that have an impact on how every diagnosis or procedure – even just a…
Payment posting in medical billing is simply the process of recording payments received from insurance companies and patients directly into…
Unbundling is when a claim bills separate procedure codes for pieces of a service that should be billed together under…
Bundled payments are a payment model where a payer sets a target price for an episode of care instead of…
Balance billing is when a provider bills a patient for the gap between the provider’s charge and the amount the…
Fee schedules are just pricing maps that tell you how much a payer plans to reimburse you for the service…
Prior authorization is a payer’s requirement that you get approval before you provide certain services, procedures, imaging or meds. This…
You should outsource hospital billing when billing work starts stealing time from running the practice and delivering quality patient care.…
The first distinction to make in your head in regards to collections is that you’re just keeping cash flow stable…
In medical billing, “medical necessity” is just the line payers use to decide whether they’ll cover a service. You can…
Electronic claim submission is the process of sending medical claims to an insurance payer digitally, instead of mailing paper forms.…
An explanation of benefits, usually called an EOB, is the notice a health plan sends after it processes a claim.…
Clean claims are just any medical claim that payers can process the first time without coming back for fixes, or…
Revenue cycle management (RCM) is the work that turns patient care into collected revenue. So essentially, it’s everything your practice…
We get how audit notices rarely come at a good time, and it’s something that generally feels even worse if…
Needless to say, any sort of write-off that’s preventable is going to hurt you twice: 1. You lose revenue 2.…
American households rack up balances for all kinds of reasons, but the most common one we see is simple sticker…
Running a small practice means you’ve got to handle everything from appointments and staff questions to supply invoices and lab…
When billing teams say “patient demographics,” they just mean the set of facts that pin a person’s identity to the…
Modifiers are essentially just quick notes that you tack on to a code. It tells the payer a service varied…
Provider credentialing is the review that payers or hospitals use so they can confirm a healthcare provider’s qualifications before that…
Claim processing turns a patient visit into money in your bank account. Simple. It links healthcare providers with an insurance…
A practice management system (PMS) is medical software that takes care of all the front-office chores you need to run…
The UB-04 – officially Form CMS-1450 – was created by the national uniform billing committee to give institutional healthcare providers…
When you scroll through a claim form, the numbers may look slightly random. But in reality, those numbers are just…
Medicaid fraud is just any deliberate false claim to the medicaid program – billing for a no-show visit or up-coding…
Your practice’s success lives or dies on cash flow, and the link between satisfied patients and steady revenue is the…
Running a medical office, especially a small one, is tough because every slip is expensive, and there’s a good chance…
Patient collection is the step in medical billing where a practice secures the portion of a bill that an insurance…
Running a skilled nursing facility (SNF) means you’ve got loads of responsibilities, but on top of patient care, you’ve got…
You can think of an EHR platform as the digital home for every chart in the practice. It: – Stores…
Understand the real difference between denied and rejected claims and what you can do to fix either. We also touch…
Payer mix is just the percentage split of your practice’s patient revenue across all your different payers. So, a few…
Denial management is the habit of spotting and preventing the denied claims that cut into your cash flow. It’s the…
At its core, physician services are any professional activity a licensed doctor performs or supervises for patients. That’s everything from…
Discover the five main medical coding classification systems and why they matter. You’ll also see how outsourcing to PMN can…
A patient co-payment is essentially proof that the patient has skin in the game – even though the insurer pays…
Cash flow tracks both the money in and money out, which shows whether your practice has enough cash on hand…
Outsourced medical billing is when you pay an outside firm to run every step of the medical billing process. This…
Explore everything from why certified medical billing matters and what credentials to look for to how PMN can help your…
Claim denial rates refer to the number of sent and unpaid insurance claims that are rejected upon first submission. You…
A medical claims audit examines the following details to check accuracy and compliance: – Claims processing – Claim administration steps…
Medical reimbursement is the process in which a payer covers a patient’s approved medical costs after they have been treated.…
Medical reporting describes the documentation and communication that you need to make for incidents and outcomes. Routine clinical data also…
Accounts payable refers to the short-term money owed by a business to suppliers and vendors. On a balance sheet, it…
Accounts receivable (AR) describes the money owed to your practice by customers after delivering goods or services. It appears as…
Healthcare fraud means knowingly submitting false information to get money or services from health care programs. It covers a range…
A credit balance refers to the amount by which credits outpace debits in a ledger. The number lands on the…
Medical coding turns notes on medical records into universal medical alphanumeric codes that describe: Procedures Diagnoses Services Each code links…
Medical billing turns the care your hospital or general practice performed during a patient encounter into a claim that’s sent…
Got issues with your medical billing and don’t know what to do with them? Learn what some of the more…
Curious about the process of earning a certified clinical documentation specialist credential? Learn how it works throughout this article. It’s…
Unsure what role medical coders actually have in your practice? Learn why they’re so essential for healthcare providers and how…
Are you a healthcare practice that’s handling both medical billing and coding? It means you have to handle a list…
Becoming a professional in medical billing and coding means learning about: – Medical terminology – Patient medical records – Insurance…
Do you understand what a medical biller actually does? Put simply, a medical billing specialist is the person between patient…
In practically any medical practice, coding is going to be at the center of the medical billing system – it’s…
Upcoding is essentially just when you bill for a medical service at a higher level than what your team actually…
What does EVV stand for and why is it in the news? EVV stands for Electronic Visit Verification. It’s essentially…
Obviously, it goes without saying that your practice deserves to be paid for the care you provide. That’s especially true…
You’ve undoubtedly heard of Medicare if you’ve spent even just a little bit of time working in the healthcare industry.…
If you’re running a small medical practice, you’re likely already able to answer a question like “what are medical codes?”…
Effective data management should always start with clear standards. But we recognize how small medical practice owners often are usually…
Between clinical care and administrative work, you need tools that streamline processes and ensure accuracy. So that’s exactly what HCPC…
There are a decent amount of complications that can come with running a small medical or dental practice – from…
Managing a thriving small practice is all about finding the balance between clinical care and the business front. As much…
Hospital billing often looks complicated. And if you run a small medical practice, you might wonder how larger facilities handle…
Durable Medical Equipment (DME) has a huge impact on patient care. The following reusable devices help people recover or simply…
Managing a thriving small practice is all about finding the balance between clinical care and the business front. As much…
One of the biggest challenges of running healthcare organizations is handling the financial aspect of patient care, often referred to…
Small medical practices lie at the heart of a community’s healthcare. Individuals feel more at home visiting a familiar local…
Today, the fast tempo of the healthcare setting has brought about numerous challenges that small medical practices go through. One…
Medical billing is an important process within the healthcare industry and represents the method in which healthcare providers get reimbursed…
Healthcare organizations, when run on a small scale, tend to have particular problems in the financial area. As such, it’s…
Running a dental practice entails so much more than offering your patients great care. To have a seamless practice, you…
Medical billing may be one of the most challenging aspects of managing a healthcare business. There are a number of…
The Quality Payment Program (QPP) is a vital initiative aimed at transforming how Medicare providers are reimbursed for services rendered…
If you’re a healthcare provider, you’ll undoubtedly know the role that medical billing plays alongside the services you provide. There’s…
Your focus as healthcare providers should always be delivering solid care to your patients – especially as a small practice…
Healthcare organizations nowadays need to keep every aspect of the center working efficiently – you may strive for perfection when…
The complex process of medical billing is well known in various practices and medical centers, but there’s a specific aspect…
Your small medical practice faces a range of tasks that go beyond basic patient care – whether that’s managing finances…
The importance of medical billing isn’t something that we need to restate, but it is something that can be particularly…
Generally speaking, regardless of how big your medical practice is, managing all of your day-to-day operations in-house can easily start…
As a small medical practice, you and your fairly limited staff usually have their hands full at pretty much all…
These terms might seem interchangeable at first glance, but they actually have fairly distinct processes that’ll cause your practice a…
Whether you’re a seasoned practitioner or a small medical practice owner, it’s generally pretty important to recognize why entity codes…
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