p3care

SEPTEMBER 14, 2023

Today, we observe that healthcare billing services have adopted an electronic claim submission method. In this blog, we’ll explore the significance of EDI in medical billing and its operational mechanics. In this blog, we’ll explore the significance of EDI in medical billing and its operational mechanics.

Integration 130

Integration Healthcare Providers Accountability Healthcare 130

Etactics

NOVEMBER 3, 2022

30% of insurance claims get denied on their first submission. Part of this is because of the complicated nature of the claim adjudication process. There’s nothing simple about the claim submission process. If you aren’t a seasoned medical biller, you are probably asking yourself, “what is claim adjudication?”

Healthcare Providers 52

Healthcare Providers Prevention Healthcare Accountability 52

Etactics

AUGUST 30, 2022

You submit a patient’s claim to their insurance payer, their payer takes a look at it and they pay you. Although that statement is technically true regarding the claim submission process, it’s definitely not easy. After all, there’s a reason why 30% of insurance claims get denied on their first submission. Easy enough, right?

Healthcare 52

Healthcare Accountability Nursing 52

Etactics

JANUARY 26, 2024

In this blog, we focus on unveiling the details surrounding the fee-for-service payment model. In 2021, the amount of healthcare payments from the fee-for-service models equaled 40.5%. There are multiple different healthcare payment models. Each method exists to provide compensation to providers for services rendered. Cost containment.

Healthcare 52

Healthcare Primary Care Medicare Healthcare Providers 52

Etactics

FEBRUARY 10, 2023

There are between 5 and 10 percent medical claim denials on average, according to the AAFP. In 2020, across HealthCare.gov insurers, reports show that 18 percent of in-network claims resulted in claim denials. Healthcare insurance companies assign these codes to claims that are unable to process. Let’s dive in.

Healthcare 52

Healthcare Healthcare Providers Medicaid Prevention 52

Etactics

SEPTEMBER 20, 2022

86% of all healthcare claim denials are avoidable. Of course, the true answer to that question is that healthcare claim submission isn’t cut and dry. After all, healthcare is in the “business” of treating patients…not catering to the claim submission requirements set forth by insurance providers. Why is this the case?

Medicare 52

Medicare Healthcare Prevention Hospitals 52

Etactics

SEPTEMBER 7, 2023

There were nearly 50 million denied healthcare claims in 2021. Based on the total number of in-network claims submitted, that averaged out to a 17% denial rate. In other words, healthcare claim denials are a plague that every healthcare organization has to not only deal with but also try to figure out ways to manage them.

Healthcare 52

Healthcare Doctors Prevention Medical Services 52