The Centers for Medicare and Medicaid Services (CMS) has come up with several incentive programs like Physician Quality Reporting System, Electronic Health Record (EHR) incentive program and Electronic Prescribing (eRx) incentive program to promote better physician practice management. Eligible P...

In the past few years, the US healthcare system is striving to enhance the quality of patient care at reduced healthcare costs. To accomplish this goal, it introduced several physician billing payment models that would replace the traditional Fee-for-Service model. Such healthcare reform models w...

The adoption of Electronic Health Records (EHR) has not only revolutionized the healthcare domain, but also made the job of documenting patient information easier for Providers. In addition, EMR software has allowed Providers to make important clinical decisions and take patient care to the next ...

In the history of the US Healthcare domain, several physician payment models, including fee-for-service, episode-based payment, and patient-centered medical home were introduced. However, most of these models failed to address the efficiency or measure of the outcomes. It is to improve the qualit...

The entire process involving medical billing and coding functions is quite tricky. Therefore, it is highly important that billing specialists ‘dot the i’s and cross the t’s’ of their claims before submitting them to the Payers. In addition, they have to pay special care in handling inpatient and ...

Medical billing and collections for Hospital affiliated specialties is a major challenge that most Healthcare Facilities and Medical groups confront in their day-to-day operations. Even as they try to tackle this problem confidently, several complications arise when the Healthcare Facility is con...

Gone are the times when Healthcare Providers got reimbursed for each and every service they rendered to their patients irrespective of the outcome. In the present era, quality is valued more than the quantity of services provided. It is better exhibited by the recently introduced Pay-for-Performa...

The RAC audit program has been around for 8 years now, having started in 2005 as a ‘demonstration project’. While it was only the Hospitals – Part A claims - that were targeted due to the higher $ value for inpatient claims, the program is slowly expanding to the Part B claims which cover physici...

The ups and downs of a Healthcare Facility’s revenue cycle are determined by the payment posting, which needs frequent reviews. If there are discrepancies in cash posting, then Providers are at a high risk of facing medical AR inflation. Regular follow-up with patient payments and insurance payme...

Charge capture is considered one of the trickiest jobs in the medical billing and coding process flow next only to Coding. Also, Coding and Charges go hand-in-hand to ensure successful payment of claims. It is for this reason that most healthcare providers use Charge Masters, which document patie...