Medical Billing Blog with Medical Billing & Coding Info & Articles
Our blog contains news and articles relating to numerous healthcare sectors including revenue cycle management, medical billing, medical coding, ICD, HIPAA, practice management functions and more.
Medical Claim Denial Management and Predictive Analytics, How Data Can Eliminate Denials
The Hidden Cost of Claim Denials in Healthcare Medical claim denials are one of healthcare’s most expensive inefficiencies. Every rejected claim represents lost revenue, delayed payments, and wasted staff time. Studies show that around 10% of medical claims are initially denied, and more than half are never resubmitted. For hospitals and physician practices, that means millions of dollars in lost reimbursements every year. Traditional denial management—chasing down denials, correcting them, and resubmitting—is costly and slow. Enter predictive analytics. By combining advanced data modeling with machine learning, healthcare organizations can now identify and prevent denials before they occur. The result: faster payments, fewer rejections, and a more efficient revenue cycle. What …
Autonomous vs Human-Assisted Medical Coding
The last five years have seen rapid adoption of automation and artificial intelligence (AI) in the medical coding space. Hospitals, physician practices, and revenue-cycle vendors all promise faster cycle times, lower labor overhead, and improved accuracy — but the reality is nuanced. Below I examine what autonomous (fully automated) and human-assisted (AI + human reviewer) coding mean in practice, summarize documented error-rate data, and lay out the practical benefits, risks, and implementation best practices organizations should consider. Definitions: what we mean by “autonomous” and “human-assisted” coding Autonomous coding describes systems that ingest clinical documentation (structured EHR data and/or unstructured clinical notes) and automatically produce ICD-10, CPT/HCPCS, modifiers, and claim bundles …
Orthopedic and Pain Management Coding
The field of orthopedic and pain management coding has evolved rapidly in recent years, driven by advances in technology, regulatory changes, and an increased focus on value-based care. As we navigate 2025, medical coders, billing professionals, and healthcare providers must stay current with the latest guidelines and emerging trends to ensure accurate reimbursement and compliance with payer and federal requirements. This article provides a comprehensive overview of orthopedic and pain management coding, highlighting key updates in CPT and ICD-10 codes, changes in payer policies, telehealth integration, and strategies to optimize coding accuracy and revenue cycle performance. The Growing Complexity of Orthopedic Orthopedic and pain management practices encompass a wide range …
A Guide to Radiology and Imaging Coding
Radiology and imaging services are a critical part of modern healthcare. These services enable medical professionals to diagnose and treat various conditions with precision and accuracy. However, delivering these services comes with a complex web of documentation, reimbursement, and compliance requirements. At the heart of this process is radiology and imaging coding—a specialized domain of medical coding. It involves the precise classification and reporting of radiological procedures and imaging tests using a standardized system of codes. This article provides an in-depth look at radiology and imaging coding, highlighting its importance, core coding systems, common challenges, and best practices. The Importance of Radiology and Imaging Coding Radiology coding plays a significant …
Managing Patient Billing and Collections in the Era of HDHPs
The healthcare landscape in the United States has significantly evolved over the last few decades, and one of the most transformative changes has been the rise of high-deductible health plans (HDHPs). These plans, which require patients to pay a substantial amount out-of-pocket before insurance coverage kicks in, have altered how healthcare providers manage patient billing and collections. While HDHPs offer lower premiums, they transfer a larger share of financial responsibility to patients, which presents challenges for both patients and healthcare providers. This article explores how healthcare providers can effectively manage patient billing and collections in the context of HDHPs. We’ll discuss the implications of these plans, the challenges they introduce, …
Coding for Chronic Care Management: A Comprehensive Guide
Chronic Care Management (CCM) has become an essential service in healthcare as the global population ages and chronic diseases become more prevalent. For healthcare providers, understanding how to properly document and code for CCM is crucial not only for patient care but also for reimbursement and compliance. This article will explore the significance of Chronic Care Management, the necessary coding procedures, billing guidelines, and how proper coding can enhance patient outcomes. Introduction to Chronic Care Management Chronic diseases such as diabetes, heart disease, chronic obstructive pulmonary disease (COPD), and hypertension are significant health challenges that affect millions of people worldwide. Managing these conditions often requires continuous and coordinated care over …
Strategies for Optimizing the Billing Process and Improving Collections
Effective medical billing is critical to the financial health of healthcare practices. Optimizing this process can lead to faster payments, fewer errors, and better cash flow, directly impacting a practice’s profitability. Conversely, inefficient billing and collections can lead to revenue loss, increased patient dissatisfaction, and financial instability. In this article, we’ll explore key strategies that healthcare providers can adopt to optimize their medical billing process and improve collections. Implementing a Robust RCM System A Revenue Cycle Management (RCM) system plays a crucial role in medical billing by streamlining the entire process, from patient registration to payment collection. By implementing a robust RCM system, healthcare providers can ensure that all billing …
Tips for Effective Medical Coding in Geriatric Care
Medical coding is a critical aspect of healthcare administration, ensuring that patient records are accurate and that healthcare providers are reimbursed correctly. In geriatric care, where patients often present with multiple, complex health issues, accurate coding is essential. Here are some essential tips to enhance the accuracy and efficiency of medical coding in geriatric care. Common Conditions in Geriatric Patients Geriatric patients often suffer from multiple chronic conditions. Familiarity with these conditions and their coding nuances is crucial. Common conditions include: Hypertension (I10): Often coded when the patient has consistently high blood pressure readings. Diabetes Mellitus (E11.9): Requires differentiation between Type 1 and Type 2, and specification of any complications. …
Introduction to Billing for Podiatry
Medical billing for podiatry involves a specialized process due to the unique nature of foot and ankle care. Podiatry practices need to navigate specific coding, insurance claims, and regulatory requirements to ensure they receive appropriate reimbursement for their services. This article will explore the intricacies of medical billing for podiatry, providing a comprehensive overview that includes understanding podiatry billing codes, insurance processes, common billing challenges, and best practices for efficient billing. Definition of Podiatry Podiatry is a medical specialty focused on diagnosing and treating conditions related to the foot, ankle, and lower extremities. Podiatrists manage various issues, including fractures, sprains, diabetic foot care, heel pain, and more. This specialized field …
Measures to Detect and Prevent Fraudulent Billing Practices
Fraudulent billing practices pose a significant challenge across various sectors, particularly in healthcare, insurance, and finance. These practices not only lead to substantial financial losses but also undermine the integrity of services and trust in these industries. Effective fraud and abuse prevention measures are essential to safeguard resources, maintain transparency, and ensure fair practices. This article delves into the key strategies and measures that can be employed to detect and prevent fraudulent billing practices. Understanding Fraudulent Billing Practices Fraudulent billing refers to the act of deliberately falsifying billing information to receive unearned benefits or payments. Common fraudulent billing practices include: Upcoding: Billing for a more expensive service than what was …
