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. In this dark, clearinghouse-less reality, providers would have to turn down insured patients who use insurances that only accept electronic claims.

Integration 52

Integration Healthcare Medicaid Healthcare Providers 52

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. Any medical biller with some experience will agree that there are a lot of steps. What is a claim?

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

Icanotes

APRIL 13, 2021

Mistakes and errors on the claims you submit to insurance companies can delay payment or cause the company to reject your claim. What Is a Clearinghouse in Health Care? The Benefits of Using a Medical Clearinghouse. How to Determine if Using a Clearinghouse is Right for Your Practice. Table of Contents.

Accountability 59

Accountability Healthcare Providers Quality of Care Regulations 59

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? A claim rejection is not a denied claim. That’s one of the biggest misconceptions about clearinghouse rejections. For reference, denials are fully processed but inaccurate claims.

Doctors 52

Doctors Rehabilitation Nursing Hospitals 52

Etactics

APRIL 6, 2023

When it comes to denial management in medical billing , the U.S. 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. This is maybe obvious, but how about the fact that there is a growing number of medical claim denials?

Prevention 52

Prevention Healthcare 52

Etactics

OCTOBER 11, 2023

One-third of all submitted claims get denied or ignored on the initial submission. That doesn’t sound great, but if you flipped the script you’re still receiving 66% of your claim revenue. In 2021 hospitals lost an average of $5 million to their total revenue due to denied claims. There’s a pattern to claim denials.

Hospitals 52

Hospitals Healthcare Accountability Medicare 52

Etactics

JANUARY 18, 2024

In this blog, we’ll explain the importance of revenue cycle management in the healthcare space. That means all things regarding claims, payments, and revenue are associated with the revenue cycle. Accurate and sufficient claims need to be created, processed, and submitted to the patient’s insurance company. Sounds simple…right?

Healthcare 52

Healthcare Doctors Healthcare Providers Hospitals 52

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. The answer is simple, claim scrubbing.

Accountability 52

Accountability Doctors Healthcare Patient Experience 52

Etactics

JANUARY 18, 2023

Nearly 15% of all claims get denied according to AARP. This amounts to over 200 million claim rejections each day! Medical billing has plenty more disheartening statistics, but I’ll spare you on all of those for now. There are ways you can avoid claim rejections and thus keep your revenue flowing. What even are they?

Healthcare 52

Healthcare Healthcare Providers 52

Etactics

JANUARY 18, 2022

First, 80% of medical bills contain errors. Second, insurance claim denial rates are well over 11%. So, even if there aren’t any errors on the medical bills you send to your patients, their insurance companies still might not compensate you on the back end. That’s exactly what this blog post covers.

Private Practices 52

Private Practices Tricare Accountability Medicaid 52

Etactics

JANUARY 11, 2022

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%. If they don’t it’s likely because they’re new to the industry.

Medicaid 52

Medicaid Integration Medicare Healthcare 52

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. Hospital stays.

Healthcare 52

Healthcare Primary Care Medicare Healthcare Providers 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 28, 2022

The truth is, though, that there really shouldn’t be any reason why the claim denial landscape is so grim. In other words, most healthcare organizations have the opportunity to collect on claims that insurance organizations didn’t initially accept…they’re just not doing it. Denial code CO 18 means, “exact duplicate claims or services.”

Hospitals 52

Hospitals Healthcare Medicare 52

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%. If you look back at our previous blogs, you can even find a few of them.

Regulations 52

Regulations Nursing Prevention Healthcare 52

Etactics

FEBRUARY 8, 2022

$262 billion worth of claims get denied on an annual basis according to HFMA. Those two data points are the reason why I made the frank remark that it doesn’t really matter how well or poorly your organization handles claims that come back from insurance providers with a denied status, there’s always room for improvement.

Medicaid 52

Medicaid Healthcare Healthcare Providers 52

Etactics

OCTOBER 25, 2022

These entities allow providers to extend medical treatment to those who may not be able to afford it. Functions such as patient reminders, calculating existing patient balances, handling claim denials, and more will be at your disposal. For example, let’s take a look at claim rejections. Outsourcing Revenue Cycle Management.

Regulations 52

Regulations Doctors Healthcare Integration 52

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. In fact, the process has gotten so laborious that sometimes it makes more sense to submit a claim without prior authorization to save time. I’m kidding (mostly).

Healthcare 52

Healthcare Doctors Hospitals 52

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. This includes a right to look over and obtain a copy of their medical records. Patients also have the right to review and obtain a copy of their medical records held by either covered entities or business associates.

Regulations 52

Regulations Accountability Healthcare Providers Integration 52

Etactics

AUGUST 10, 2022

Some examples of business associates include… Third-party companies that assist with claims processing and medical billing companies. Healthcare clearinghouses that handle claims before forwarding the processed transaction to a payer. So, how and why does HIPAA apply to anyone outside of medical providers and the patient?

Accountability 52

Accountability Hospitals Healthcare Healthcare Providers 52

Etactics

JANUARY 26, 2023

Table of Contents Patient Notification Requirements Ethical Leaving Practice Notifications Example 1: Mail Letter Example 2: Email Example 3: Social Media Example 4: Blog Post Conclusion Patient Notification Requirements Therapists have many obligations to their clients that ensure their best interests come first.

Private Practices 52

Private Practices Regulations Healthcare 52

Etactics

APRIL 26, 2022

Between patient pay preferences and communicating with insurance organizations on the claim side , things get a little dicey. That might be what led you to this blog post. Burnout rates are so high within this industry that some are walking away from their medical careers altogether. I’m being facetious. How about this one?

Accountability 52

Accountability Patient Experience Healthcare Healthcare Providers 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

Etactics

JANUARY 12, 2023

In other words, healthcare workers aren’t allowed to talk about you or your medical situation without your consent. Not only that but it exposed people's medical charts and files, stuff that falls under the Minimum Necessary Standard. Especially if your argument involves the patient’s medical condition.

Accountability 52

Accountability Hospitals Regulations Healthcare 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 do I mean by precautions?

Healthcare Providers 52

Healthcare Providers Medicaid Healthcare Prevention 52

Etactics

MARCH 17, 2022

It applies to covered entities such as health plans, healthcare providers, and healthcare clearinghouses. If you see any businesses that claim their training will certify your organization for HIPAA compliance, be wary. But for the sake of this blog, we’ll cover the HIPAA Privacy Rule, Security Rule, and Enforcement Rule.

Regulations 52

Regulations Healthcare Providers Healthcare Accountability 52

Cloud Blogs

OCTOBER 28, 2020

They observed patients were not just social distancing but medical distancing as well, by having elective procedures canceled or deferred. The post Partnering to reimagine better experiences and better care for patients appeared first on Microsoft Industry Blogs.

Patient Experience 52

Patient Experience Integration Healthcare Healthcare Providers 52