Medical Billing Blog: Section - Denials
Archive of all Articles in the Denials Section
This is the archive containing links to all articles written in the Denials section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
The Importance of Denial Management in Healthcare Revenue Cycle
The healthcare revenue cycle is a complex, multifaceted process that encompasses everything from patient registration and service provision to billing and collections. A critical, though often underappreciated, component of this cycle is denial management. Given its direct impact on an organization’s financial health, understanding, and effectively managing denials is paramount for healthcare providers. Denial management refers to the process of investigating, appealing, and mitigating payment denials by insurance companies. It’s a pivotal part of revenue cycle management (RCM) that ensures healthcare providers are compensated for the services they deliver. However, despite its importance, many organizations face challenges in effectively managing denials, leading to significant revenue loss and operational inefficiencies. This …
Defining the Role of a Medical Billing Clearing House
The importance of a clearing house in the medical world cannot be overemphasized. Also called Third Party Administrators (TPAs), clearing houses make healthcare payment seamless by serving as a link between the hospital, patient, and insurance provider. The role of the clearing house is to interact with the billing system of a hospital, clinic or physician’s office to evaluate medical claims. It sets up necessary documents for patients with claims before forwarding them to the insurer. Typically, a clearing house has strong ties with various insurance providers. Clearing houses aren’t restricted to just collecting documents and ensuring proper documentation for the claim/claims of patients, they are also saddled with the …
The Importance of A/R and Outstanding Medical Claims
Accounts receivable (A/R) management is an integral part of the medical billing process and it is crucial for the financial stability and success of healthcare facilities and medical practitioners. Accounts receivable is referred to as the sum of money owed to the medical practitioner or healthcare provider for the service provided, but not yet paid. The medical services that are rendered by physicians, nursing homes, therapists, laboratory technicians, and hospitals are continuously increasing. An efficient insurance model assists a medical practice in recovering overdue payments from insurance carriers easily and on time. This is when a diligent A/R employee, or department is important, they assist the healthcare provider in being …
Medical Billing vs Medical Coding, What’s the Difference?
Medical coding and medical billing are two of the reimbursement systems within the healthcare organization. The professionals who perform these tasks are known as medical coders and medical billers, respectively. The work of medical coders and medical billers is to analyze medical treatments received by patients while at a healthcare facility to coordinate payments from insurance companies and patients. In this article, we will discuss the difference between medical coding and medical billing. However, it is important to have a brief understanding of what medical coding and medical billing entail. What is Medical Coding? Medical coding is a way of converting healthcare diagnosis, procedures, medical services, and equipment into universal …
RCM tip: Use an automated solution to tackle claim denials
As healthcare organizations continue to struggle with claim denials, an automated solution can help limit the issue, according to Kevin Lathrop, president of TriZetto Provider Solutions, a Cognizant company. Mr. Lathrop shared the following tip with Becker’s Hospital Review. “One way to keep denials from happening in the future is by stepping away from the manual processing that takes place at a computer terminal, and replacing it with an automated claims and denials system. An automated system has the benefit of knowing payer codes. Treatment codes change over time and must be kept up-to-date. Keeping track of them by hand is difficult and time-consuming, but an automated solution has the …
