Etactics

JANUARY 18, 2023

Medical billing has plenty more disheartening statistics, but I’ll spare you on all of those for now. Being in the medical billing field, you have to stay on your toes… but you already knew that. Knowing the different denial codes and what they stand for is just part of the equation. What is a denial code?

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Etactics

APRIL 26, 2024

Now, I’m no lawyer, hearsay, but this blog is about what a payer agreement is. Some of the topics outlined in a payer agreement are reimbursement rates, coverage, claims submission, billing procedures, payment terms, compliance requirements, and a termination clause. The next section of this blog will be your payer agreement glossary.

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Best Medical Billing Company | Physicians Revenue Group, Inc.

MARCH 30, 2023

Admin March 30, 2023 How Orthopedic Medical Billing Works? Orthopedic medical billing and coding involve complex musculoskeletal disorders like fractures, arthritis, and dislocations. Secure your claims from an intermittent refusal by accurately filling bills. That’s why we incorporate robust billing software.

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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. These denial rates vary from individual providers as well. But what are denial codes? Let’s dive in.

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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%. Why are denials such a pain? Let’s look at the common denial code PR 204!

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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 If you’re reading this and you’re in the medical billing field, I’m sure I don’t have to spell out why these numbers seem to be on the rise.

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Etactics

DECEMBER 1, 2023

Did you know that poor billing practices cause American doctors to lose around $125 billion each year ? Medical billing and coding has many challenges. If you keep up with our blogs or work in the industry, you know exactly what I’m talking about. For example, two terms are commonly misunderstood by billing professionals.

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Etactics

JANUARY 18, 2024

In this blog, we’ll explain the importance of revenue cycle management in the healthcare space. It’s used internationally to identify the cause and or reason that a patient is seeking medical treatment. These codes explain the medical procedures performed/provided to patients during their appointments.

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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? seconds.

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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. Not many people can confidently say they understand everything about the medical billing and coding system.

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Etactics

APRIL 11, 2023

The American Medical Association’s most recent study found that major payers return to up to 29% of claims with $0 payment. It also happens 7% of the time because of claim edits and 5% of the time because of other denials. A study by the Medical Group Management Association found that it costs about $25 a claim to rework the claim.

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Etactics

DECEMBER 15, 2021

The term “denial” in the healthcare world has two meanings. Second, it’s a term that’s best described as one of a medical organization’s worst nightmares. You see, the second meaning for denial in healthcare happens when an insurance organization doesn’t accept services rendered by a physician. First, the obvious.

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Etactics

APRIL 5, 2024

Telemedicine, also known as telehealth, is remote medical care. There are differences between billing for in-person services and remote services. Healthcare providers must understand correct billing practices regarding telemedicine. Billing practices are still important to ensure accurate and timely payment for their services.

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Etactics

SEPTEMBER 20, 2022

86% of all healthcare claim denials are avoidable. Either way, the fact of the matter is that healthcare organizations can’t afford to forego the revenue associated with their avoidable claim denials. Healthcare organizations struggle with certain denial codes more so than others. One of those common denial codes is CO-16.

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Etactics

FEBRUARY 15, 2022

In 2017, an American Medical Association (AMA) found that healthcare facilities spend two days every week working through prior authorization (PA) requirements on average. Sure, doing that strategy 100% guarantees that the submitted claim will come back as a denial. Here are 3 powerful prior authorization denial sample appeal letters.

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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! These services may include room and board, imaging services, medications, and more.

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Etactics

JANUARY 26, 2024

In this blog, we focus on unveiling the details surrounding the fee-for-service payment model. As is anything in the medical billing industry, there are different hoops and roadblocks to maneuver through. Prescription Medication. Durable Medical Equipment (DME). Buckle up, this might be a bumpy ride.

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Etactics

JANUARY 18, 2022

Whether you’re a seasoned behavioral health professional that just opened a private practice or a biller that just landed your first job at a facility, you have to figure out how to bill insurance companies for counseling services. Two statistics help paint the dismal picture that is billing insurance companies. It’s not that easy.

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Etactics

AUGUST 30, 2022

Every experienced medical biller will tell you that there is a lot more involved in the three steps I just listed and that it’s the minutiae that matter most within each step. This scenario happens when the payer finds that the billed service level isn’t appropriate according to the diagnosis or procedure codes. Easy enough, right?

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Etactics

OCTOBER 25, 2022

These entities allow providers to extend medical treatment to those who may not be able to afford it. Revenue cycle management, or RCM, is a term used to describe how healthcare organizations track their patients from registration to billing. One of the main perks is the ability to automate your administrative and billing duties.

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Etactics

DECEMBER 21, 2021

Ask any medical biller what their arch-enemy is and they’ll identify one of the two main types of codes that they work with. Although both types of those codes are an essential part of the medical billing process, they lead to a lot of headaches for billers and the organizations they represent. But, that comes at a premium.

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Etactics

JANUARY 11, 2022

If you mention the word “billing” to any mental professional, they’ll shutter. Although the billing rules within the mental health space seem archaic, the practice sends shivers down the spine across the entire medical world…regardless of specialty. You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%.

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Etactics

NOVEMBER 3, 2022

Any medical biller with some experience will agree that there are a lot of steps. Billing isn’t as simple as submitting a claim to a patient’s insurance payer, the payer reviewing the document, and you gett paid. If you aren’t a seasoned medical biller, you are probably asking yourself, “what is claim adjudication?”

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Etactics

FEBRUARY 8, 2022

it would amount to around $5 million worth of denials per. If the average dollar amount of denials costs providers that much, regardless of the size of their practice, how are they supposed to keep their doors open? The reality is that the denial landscape is different for every healthcare organization. I must confess, though.

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Icanotes

APRIL 13, 2021

The Benefits of Using a Medical Clearinghouse. To streamline the billing process and reduce the number of errors that occur, many providers work with medical clearinghouses, which review and scrub claims before submitting them to insurance. The provider submits the claim to the medical clearinghouse.

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Etactics

JULY 1, 2021

One of the careers that I’m referring to, of course, is medical coding. But I’ll answer that question the long way for the rest of this blog post. Don't Panic: What's Changing There’s no way to ignore the upcoming changes to medical coding brought forth by technology and AI. Medical coding is different.

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Etactics

SEPTEMBER 1, 2023

To put it simply, these file types are essentially the bill and the receipt. The Importance of The Right Clearinghouse Conclusion Defining Healthcare Claims and Remittances If you held a conversation with a claims clearinghouse or a medical biller about the revenue cycle. Naturally, that also means fewer claim rejections and denials.

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Etactics

OCTOBER 27, 2022

Medical billing is a headache. After all, you clicked to read this blog post because of those pesky rejection codes, right? For reference, denials are fully processed but inaccurate claims. From a clearinghouse perspective, a claim bounces back to you because of a preliminary step in the medical billing process.

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Etactics

SEPTEMBER 7, 2023

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. But, in our 20+ years of business as a medical claims clearinghouse with a focus on denial management, we’ve noticed a pattern.

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Etactics

JULY 8, 2021

They might show up repeatedly in the emergency room, have complex medical problems, have low health literacy, use a number of medications, visit multiple specialists, etc. Most potential patients search for physicians and medical practices on their phones or tablets. You’ve heard coworkers refer to them as “frequent-flyers.”

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HIT Consultant

AUGUST 2, 2022

According to the American Hospital Association (AHA), medical records, billing, and compliance are the fastest growing healthcare white-collar administrative professions, expected to grow 13% by 2026 2. Medical Records and Health Information Specialists. References. US Bureau of Labor Statistics. Occupational Outlook Handbook.

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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. Yet these denials aren’t uncommon. Even if you’ve been here for a while, it’s still a challenge.

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Physical Therapy Accountability Medicare Medicaid 52

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. Yet these denials aren’t uncommon. Even if you’ve been here for a while, it’s still a challenge.

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Physical Therapy Accountability Medicare Medicaid 52

Etactics

MAY 19, 2023

Medical billing and coding is an important piece of the revenue cycle puzzle. Proper training for your staff, staying up to date with industry standards and reforms, and utilizing third-party clearinghouse systems are just a few essential tools you should have in your medical billing tool belt. What is Denial Code CO 151?

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Etactics

JUNE 2, 2023

In this blog, we will discover what a CPT code is, different kinds of CPT codes, why they exist, and how they help you collect revenue. These CPT codes are universally accepted medical vocabulary. Healthcare professionals use this nomenclature to bill public and private insurance companies for the services and procedures they provide.

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Etactics

FEBRUARY 10, 2022

This covers services such as… Surgeries Dental care Medication prescriptions Behavioral therapy Cancer treatment Transplants Physical therapy. But for the sake of this blog, let’s focus on physical therapy. Elderly people have a higher chance of experiencing health conditions that would require medical attention. They saw $31.5

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