Archive for The Year of 2025
Archive for the Year of 2025
Welcome to the medical billing blog archive for the entire year of 2025.
Here you will find links to every article added to the Outsource Management Group web site during 2025.
You can browse this year's archives by clicking the "More" button from any of the excerpts below.
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 …
