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. A more recent study found that the total denial rate increased by 3% more in 2022 than in 2021. The key is implementing a solid healthcare denial management process.

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Etactics

JANUARY 18, 2024

The revenue cycle process is what keeps hospitals, small practices, and larger healthcare systems financially healthy. When we think of the healthcare industry, the business aspect of how these institutions run may not come to mind. It’s no surprise that healthcare organizations need money to keep the lights on.

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Etactics

FEBRUARY 15, 2024

Claim denials continue to plague the healthcare system, bogging down medical billing personnel when it comes to their day-to-day tasks. Having to regularly handle these denials means time stripped from other duties such as collecting patient payments and processing existing claims. Table of Contents What is Denial Code CO 29?

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Etactics

JANUARY 19, 2024

Having a fortified revenue cycle management system! It is one of the pillars of your revenue cycle management system that you cannot afford to overlook. It is one of the pillars of your revenue cycle management system that you cannot afford to overlook. Denial posting. Reviewing information from payers.

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Etactics

JANUARY 18, 2023

Knowing the different denial codes and what they stand for is just part of the equation. With our clearinghouse services, we regularly assist companies with managing the many parts of their billing ecosystem. From claim scrubbing to real-time alerts on denials so you don’t have to wait weeks on insurance companies. Conclusion.

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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. In 2020, across HealthCare.gov insurers, reports show that 18 percent of in-network claims resulted in claim denials.

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Etactics

SEPTEMBER 28, 2022

One in every three hospitals reports that their denial rate is 10% or higher according to Harmony Healthcare. A denial rate that high is what’s considered to be the “danger zone” when it comes to denials. How have hospitals let their denial rates hit such alarming percentages? What is denial code CO 18?

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Sheppard Health Law

JANUARY 19, 2024

You can find more information regarding the Act on the Sheppard Mullin Healthcare Blog. Require plans and issuers to register in the Federal IDR portal. The original comment period closed on January 2, 2024.

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Etactics

APRIL 6, 2023

When it comes to denial management in medical billing , the U.S. Healthcare Denial Management Markets , in 2021 denial management reached a value of $3.54 This is maybe obvious, but how about the fact that there is a growing number of medical claim denials? In fact, according to the U.S.

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Etactics

SEPTEMBER 20, 2022

86% of all healthcare claim denials are avoidable. A lot of the revenue loss that healthcare organizations experience is preventable. Of course, the true answer to that question is that healthcare claim submission isn’t cut and dry. Healthcare organizations struggle with certain denial codes more so than others.

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Etactics

APRIL 13, 2023

When dealing with medical claim denial statistics, Experian Health has some great examples. For instance, according to their 2022 State of Claims Survey , 30% of health professionals say that claim denials are increasing anywhere from 10% to 15%. Healthcare providers often don’t have the manpower or experience to prevent claim denials.

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Etactics

MAY 19, 2023

The top concerns for claim denials are as follows: Coding 32% Medical Necessity Acute IP 30% Front-End 20% Clinical Validation Denials 18% The good news is that approximately 34% of claim denials are absolutely avoidable, with about 86% of them being potentially avoidable. Table of Contents What are Denial Codes?

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Etactics

APRIL 26, 2024

On average, a healthcare provider has between 16 and 20 payer contracts. These payer contracts, also known as payer agreements, ensure that healthcare providers receive proper reimbursement for the care they provide to patients that get covered by a payer. Now, I’m no lawyer, hearsay, but this blog is about what a payer agreement is.

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Best Medical Billing Company | Physicians Revenue Group, Inc.

MARCH 30, 2023

Offer orthopedic services with freedom while we manage the Orthopedic Medical Billing A/R collections and claim follow-up for fast payment approval. Data Transfer Over A Secure Channel Technology brings revolution and quickly changes the healthcare system for the better. These surge your denial rate.

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Etactics

DECEMBER 1, 2023

If you keep up with our blogs or work in the industry, you know exactly what I’m talking about. Even if you’re new here, or just getting started in your career, the American healthcare system should speak for itself - nothing about it is straightforward. Preventing denial codes is essential if you want to keep a steady revenue flow.

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Etactics

OCTOBER 25, 2022

If you’re a veteran in the healthcare field, I’m sure healthcare revenue cycle management comes second nature to you… or you at least know what it is. Providing healthcare no longer just stays between a doctor and the patient, it now involves many different parties. Managing your revenue cycle alone can be overwhelming.

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Etactics

OCTOBER 20, 2023

According to a KFF report , 2021 saw an increase of 17 percent in in-network claim denials. However, average insurer denial rates can vary widely, depending on the payer and practice involved. Even so, those numbers and codes are essential for running a streamlined revenue cycle management process. So what can you do?

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Etactics

JANUARY 25, 2022

Although this scenario affects every healthcare organization, let’s say you’re a therapist who just recently opened. You’ve read countless blogs about mental health billing , established a process that’s right for you and submitted your first claim. Anyway, you went through your new process and submitted your first claim!

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Etactics

DECEMBER 21, 2021

Unfortunately, that also means both of those types of codes fall under the category that accounts for a lot of denials for healthcare organizations. Front-end revenue cycle processes account for half of all claim denials on average. So, what can medical billers do to cut down on front-end claim denials? Make sense?

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Etactics

MAY 11, 2023

In 2021, around 16% of all medical claims submitted received a denial code. Understanding the healthcare billing process and the specific standards that are in place is a great place to start. So we are here to help you with this blog! Examples of other universal codes that healthcare facilities use are: ICD-10 for diagnosis.

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Etactics

NOVEMBER 3, 2022

According to Healthcare.gov , a claim is a request for payment that a healthcare provider submits to a health insurer for items and services potentially covered by the insurer. Healthcare organizations use these documents for reimbursement from insurance companies (aka payers). If that sounds confusing, let me break it down further.

Healthcare Providers 52

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Etactics

FEBRUARY 16, 2022

If you’re new to working in healthcare, you may be feeling overwhelmed by the complexities of medical billing. You need to make sure that you do it right the first time so that you don’t end up with claim denials. You need to make sure that you do it right the first time so that you don’t end up with claim denials.

Physical Therapy 52

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Etactics

FEBRUARY 16, 2022

If you’re new to working in healthcare, you may be feeling overwhelmed by the complexities of medical billing. You need to make sure that you do it right the first time so that you don’t end up with claim denials. You need to make sure that you do it right the first time so that you don’t end up with claim denials.

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Etactics

JANUARY 11, 2022

You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%. At the time that was an all-time high and the survey that that statistic came from suggested that denial rates weren’t slowing down. Fair warning, I’m about to bring in another general statistic to help paint the healthcare billing landscape.

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Etactics

JUNE 2, 2023

In the United States, insurers process over 5 billion healthcare claims annually. To be able to process these claims , healthcare professionals must provide details on the services and procedures provided. Evaluation and Management Services. Developing medical guidelines and other forms of healthcare documentation.

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NASHP

AUGUST 30, 2023

To learn more about this model act, check out our blog, Rural Emergency Hospitals: Model Legislation and Considerations for States. Title This Act shall be known and may be cited as the Rural Emergency Hospital Act. The intent of the Rural Emergency Hospital license is to ensure access to rural emergency services for residents of this state.

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Etactics

JANUARY 26, 2024

In 2021, the amount of healthcare payments from the fee-for-service models equaled 40.5%. There are multiple different healthcare payment models. The models are all different in their method of reimbursing healthcare professionals, each addressing different aspects of: Healthcare delivery. So how does FFS work?

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Etactics

SEPTEMBER 1, 2023

Recovering revenue from healthcare insurance providers is one of the most important aspects of running a modern-day practice. After all, there’s a reason why most healthcare organizations seek to outsource their revenue cycle management entirely. Let’s take a deeper look at these types of healthcare claims.

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Etactics

FEBRUARY 1, 2022

If you mentioned the word “clearinghouse” to a healthcare professional, you would get one of two reactions. Clearinghouses are a required piece to the modern healthcare puzzle. Without them healthcare would essentially grind to a screeching halt. Without them healthcare would essentially grind to a screeching halt.

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Etactics

JULY 1, 2021

But I’ll answer that question the long way for the rest of this blog post. Furthermore, the skills that medical coders develop over the course of their career are translatable into other healthcare information technology (IT) areas. I imagine you’ve seen some of these headlines too. Here’s the reality. I haven’t changed my mind.

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Regulations Healthcare Accountability Doctors 52

Etactics

APRIL 5, 2024

Healthcare providers must understand correct billing practices regarding telemedicine. This technology such as phone calls, video conferences, and other platforms. This is much different than a traditional in-person doctor’s visit. Telemedicine opens the door to treating patients from the comfort of their own homes and beyond.

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Etactics

AUGUST 4, 2023

Let’s start by discussing some of the basic terms you are about to hear me say over and over throughout this blog. A covered entity is anyone who performs healthcare operations, such as providing treatment or collecting payments. The provision of healthcare to the individual. million USD.

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NASHP

AUGUST 30, 2023

To learn more about this model act, check out our blog post, Rural Emergency Hospitals: Legislative and Regulatory Considerations for States. Title This Act shall be known and may be cited as the Rural Emergency Hospital Act. Drafting Note : Rural emergency hospitals are defined in accordance with federal regulations, 87 Fed Reg.

Hospitals 52

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Sheppard Health Law

JANUARY 26, 2024

The payers impacted by the Final Rule include Medicare Advantage (“MA”) organizations, state Medicaid and Children’s Health Insurance Program (“CHIP”) agencies, Medicaid and CHIP managed care plans, and plans on the Affordable Care Act exchanges (collectively, “Impacted Payers”). at 45 CFR 170.215(a)(1); US Core IG STU 3.1.1

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Etactics

FEBRUARY 10, 2022

But for the sake of this blog, let’s focus on physical therapy. There is a slew of medical codes dedicated to this side of healthcare. Whether you want to learn about the hidden side of healthcare or need to better understand physical therapy medical billing, a good place to start is with common CPT codes. billion in revenue.

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Readiness Rounds

MAY 28, 2021

have allowed our national leadership to manage the process so very poorly was, and still is, very unsettling for me on a personal level, as well as for those who’ve unnecessarily lost loved ones. government’s failure to lead, manage and protect our citizens. Embracing a series of common-sense approaches in the U.S. Not wear a mask.

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Readiness Rounds

MAY 28, 2021

have allowed our national leadership to manage the process so very poorly was, and still is, very unsettling for me on a personal level, as well as for those who’ve unnecessarily lost loved ones. government’s failure to lead, manage and protect our citizens. Embracing a series of common-sense approaches in the U.S. Not wear a mask.

Accountability 52

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