On October 1, 2025, payors and at least one major has announced they will start downcoding will implement policies that automatically reduce high-level Evaluation & Management (E/M) services when the submitted diagnosis does not justify the complexity of the visit. For many providers, this might sound like “just another payer [...]
Medical billing compliance is crucial for healthcare providers to avoid financial penalties, legal actions, and revenue losses. Strict regulations such as HIPAA, the False Claims Act, and Medicare guidelines demand accuracy and transparency in billing practices. Non-compliance can result in audits, claim denials, and hefty fines. In this blog, we’ll [...]
AR management in medical billing is essential for healthcare providers, like hospitals, clinics, and medical practices, to make sure they get paid for the services they provide. AR stands for Accounts Receivable, which means the money that is owed to a healthcare provider by patients or insurance companies for services [...]
In the world of healthcare, accurate coding is essential for ensuring that services are correctly billed and reimbursed. One of the most commonly used coding systems in the United States is the Healthcare Common Procedure Coding System (HCPCS). This system is used to code a wide variety of healthcare services, [...]
In today’s fast-paced healthcare environment, managing the financial aspects of medical services can be overwhelming for healthcare providers. One of the most critical parts of this management is the revenue cycle, which covers everything from scheduling patient appointments to collecting payments. For many healthcare providers, handling the revenue cycle in-house [...]
Medical billing is a crucial, yet highly complex, component of healthcare administration. From dealing with insurance companies to handling claims and navigating through denial management, billing can become a time-consuming burden. Enter outsource medical billing services—a solution that not only eases the administrative strain but also provides measurable financial benefits. [...]
In today’s healthcare environment, getting billing right is more important than ever. Accurate billing ensures that providers receive proper reimbursement, but mistakes can lead to serious financial consequences. This is where medical billing audits come into play. They are essential for healthcare providers aiming to enhance accuracy, prevent compliance problems, [...]
Did you know that nearly 15% of medical claims are denied? For healthcare providers, every denied claim represents lost revenue, extra administrative work, and frustration. Efficient denial management in medical billing is essential to minimizing revenue loss and ensuring smoother payment cycles. In this article, we’ll explore everything you need [...]
Running a small medical practice is no small feat. Between seeing patients, managing staff, and keeping up with the latest medical advancements, the last thing most healthcare providers want to worry about is medical billing. Yet, without an effective billing process, even the best medical care can’t sustain a thriving [...]