Adhering to Regulations and Ethical Standards with a Compliance Program in Medical Billing As healthcare organizations continue to expand, it is important for them to ensure that their billing practices are conducted in accordance with both regulations and ethical standards. An effective way to do this is with a compliance program in medical billing. What […]
Category: Medical Billing
What is the purpose of a revenue code review in medical billing and how does it impact the accuracy of billing for healthcare services?
Why Revenue Code Review Is Key for Accurate Medical Billing Medical billing accuracy is a core component of providing quality healthcare services. Revenue code reviews are an essential element of a medical biller’s role in achieving this accuracy. Revenue code reviews involve a comprehensive review of the codes for the services provided by a healthcare […]
What is the role of HCPCS codes in medical billing and how do they differ from CPT codes?
HCPCS codes and their role in medical billing HCPCS codes are a type of medical classification system used in medical billing and insurance claims, to determine the cost of a medical procedure. These codes assign a specific value to a given procedure, such as an office visit, lab work, or equipment rental. They are one […]
What is the purpose of an Indirect Medical Education (IME) adjustment in medical billing and how does it influence Medicare reimbursement for teaching hospitals?
Understanding the Role of an Indirect Medical Education (IME) Adjustment in Medical Billing for Teaching Hospitals It’s no secret that teaching hospitals receive more funding for their services from Medicare than other hospitals. Understanding the purpose and influence of an Indirect Medical Education (IME) adjustment in medical billing is necessary for teaching hospitals. What is […]
What is clinical validation in the context of medical billing and how does it ensure the accuracy and legitimacy of healthcare claims?
Understanding Clinical Validation and Its Role in Medical Billing Medical billing is complex and requires accuracy in order to ensure the legitimacy of healthcare claims. Clinical validation is an important step in this process which helps to ensure accuracy and legitimacy. Clinical validation is a process in which medical records, patient treatments, and diagnoses are […]
What is the role of a Pharmacy Benefit Manager (PBM) in healthcare and how does it influence prescription drug coverage and billing?
The Essential Role of PBMs in Healthcare A Pharmacy Benefit Manager (PBM) is a third-party organization that acts as an intermediary between health plan sponsors, such as employers or insurance companies, and pharmacies. PBMs are essential to the healthcare industry, as they provide the infrastructure necessary for health plans to offer a variety of prescription […]
What are Bundled Payments for Care Improvement (BPCI) initiatives and how do they reshape the financial structure of healthcare services and medical billing?
How Bundled Payments for Care Improvement (BPCI) are Reshaping Healthcare and Medical Billing The changing healthcare landscape is introducing innovative solutions to reduce costs, improve patient outcomes, and simplify medical billing and payment processes. One of the most talked-about models is the Bundled Payments for Care Improvement (BPCI) initiatives. BPCI is shaking up how medical […]
What is an Independent Medical Examination (IME) in medical billing and how does it affect the assessment of a patient’s medical condition and treatment?
Understanding the Benefits of an Independent Medical Exam An Independent Medical Examination (IME) is a medical examination performed outside of a patient’s usual care setting and conducted by a physician or specialist who is not connected with the patient’s current medical team. An IME provides medical opinions, which can help inform and influence decisions related […]
What is balance billing and when is it typically used in medical billing practices?
Understanding Balance Billing in Medical Billing Practices Balance billing is an increasingly common practice in the healthcare industry, and understanding how and when it is used is important for both patients and providers. Balance billing is an arrangement made between a patient and healthcare provider to fill any gaps between what an insurer covers and […]
How do Health Insurance Exchanges influence the healthcare landscape and what is their role in medical billing and insurance coverage?
The Healthcare Landscape Evolution: Introducing Health Insurance Exchanges. The introduction of health insurance exchanges has revolutionized the healthcare landscape, providing new pathways for insurance coverage and medical billing. As a result, the way patients receive medical care is changing rapidly. What are Health Insurance Exchanges? Health insurance exchanges provide individuals and small businesses the option […]