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Pre Authorization OR Prior Authorization is the process of obtaining prior approval from the payer (insurance company) before a healthcare provider provides services to a patient; also known as prior approval or pre-certification, it is the health insurer’s confirmation that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary.…

The healthcare industry has always been reluctant to use robotic process automation (RPA) to investigate new possibilities. With the implementation of different healthcare reforms, many firms have begun to use RPA and other creative technology to remain compliant and competitive. With its promise of delivering more intelligent operations by carrying out rules-based tasks at fast…

Finance and accounting play a critical part in the operation of any small firm. Starting and maintaining a small business is never simple, and running a business without adequate financing and operating capital is nearly impossible. When you’re running a small business, you need to remain on top of your bookkeeping. Your firm will fall…

The key to transitioning towards digital acceleration is to incorporate the power of AI into your business operations. Many business leaders have started to reinforce their tech-savvy side in these transformational times to prepare for the demands of our new normalcy. About why? Because it’s the best time right now to equip your business with…

The medical billing process’s bureaucracy and behind-the-scenes conspiracies mean that the revenue cycle is much more complicated than in the days before the industry started introducing software automation tools to the mix. The medical billing process today is also so complex that it is typical for bills to take not only days, but months to…

The COVID-19 pandemic has shifted telemedicine from an anomaly and outlier to a necessity overnight, and doctors say they can’t see ever going back to their old model of care. As we experience a resurgence in Covid-19 cases, healthcare consumers are continuing to adjust their expectations for what healthcare will look like in the future.…

In these difficult times of disruption, such as COVID-19 pandemic, Data management and analytics are essential to managing both the current disruption and the move to a “new normal” The COVID-19 pandemic has proven to be a catalyst for organizations to question their data capabilities and to reassess their data management strategies. Large amounts of…

Accounts receivable is one of the major factors in the revenue cycle management. With almost all major economies of the world coming to a standstill due to stringent lockdown and social-distancing measures, most organizations are reeling for cash. The tremors of disruption have been felt across supply chains. Hospital administrators are doing their best to…

As the world continues to deal with the COVID-19 pandemic, telehealth is emerging as an effective and sustainable solution for precaution, prevention and treatment to stem the spread of COVID-19 and is offering an excellent way for practices across the country to care for patients. Telemedicine which is used for those with and without the…

The world population is in billions and it keeps growing. Since the pandemic, more and more people are working from home. Technologies just like the Internet of Things, edge computing, and AI are being adopted at increasingly rapid rates. It’s phenomenal to contemplate the amount of change we are all currently experiencing. On numerous levels,…

Setting up an efficient AR (accounts receivables) management strategy is an important part of any successful business. Even though there is no such company which intends to adopt weak accounts receivable policies but lack of planning or a failure to focus on any function can result in unintended consequences. Maintaining a healthy cash flow is…

For healthcare organizations with an inefficient A/R infrastructure, billing is usually delayed or are often inaccurate. This can lead to a reduced bottom line alongside worsening your patients relationship with your hospital when inefficiencies occur. Without the acceptable A/R structure, administrative issues and redundancies may exist which will have a significant impact on the efficiency…

The majority of data in the world has been generated over the last few years. As we have adopted the Internet of Things, we’re now on track to beating any and all records of data generation year-on-year. Over the time, you may have realized the importance of data and the need to govern it properly…

The global COVID 19 pandemic attack has gone far beyond thousands of infections and deaths and has affected almost all sectors. Healthcare organizations and medical billing companies being in the vanguard during this travail state are most vulnerable. The pandemic has resulted in the closure of businesses and job losses on a scale that hasn’t…

Healthcare revenue cycle management is the financial process that facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. The process encompasses the identification, management, and collection of patient service revenue. The industry-wide transition from fee-for-service to value-based care reimbursement will bring changes to traditional revenue cycle management.…

Healthcare providers are already working in battle mode, preparing new plans to respond to the growing amount of coronavirus patients, from sourcing rapid diagnostic kits to securing sufficient personal protection equipment for workers and figuring out where to place an overflow of patients. For healthcare organizations on the front lines of this pandemic, another source…

Today, data management has become the topmost need for companies. But, have you ever wondered where exactly data management came from? Let us explore more about the overall insights on data management services. When did it all start?It is said that data management came into existence in the 1890s. It all started when mechanical punch…

In today’s competitive healthcare sector, organizations have been experiencing tremendous administrative pressure along with increasing operating expenses. To cope with this, you need advanced tools at your disposal to keep your medical organizations’ finance profitable. This is where efficient revenue cycle management comes into the picture. Hence, we have introduced the most powerful strategies in…

Besides doctors, the skilled medical office staff is the backbone of every medical organization. However, the staff engaged in coding and billing stays at the back end of the whole process and a slight mistake in their work impacts the bottom line as well as the revenue generation of the organization. In most organizations, the…

Every business implements proper collection, verification, protection, and utilization of data in order to achieve success for which the right tools need to be implemented. The tools if implemented in an apt way will help convert potential leads into customers.  Nowadays, the collection of data plays the most vital role in modern businesses. However, the…

With the ever-increasing and incessantly evolving facets of the medical industry, it is quite natural that new regulations may get introduced in the domain. In fact, medical organizations, as well as businesses, are seeking for the most efficient ways to manage their revenue. Amidst these needs, outsourcing medical services have created a buzz in the…

Accounts receivable is one of the major factors in the revenue cycle management of all kinds of organizations. However, the medical billing industry is one of them. Most of the insurance companies pay large amounts of bills without which any hospital’s or medical organization’s expense cannot be recovered. This results in the improper medical care…

In the current digital age, data is everything for any business. It is one of the most important assets of any company. It is the basic yet foundation part of any company that helps the people to make a decision on their business. So, the data should be accurate, complete, organized and consistent, it is…

Today, the competition is growing high even in the medical field. However, the competition relies on the accuracy and efficiency in the medical coding. Also, submission of the medical claims is highly significant. Medical coding is a complex and time-consuming process that is expensive when it is completed in-house. With lots of challenges in this…

Charge entry is a handy concept in medical billing. Typically, in medical billing, patient accounts are created with their appropriate value following the coding and fee schedule. The charges that are entered into the system will determine the physician’s service reimbursement. As such, utmost care must always be considered to avoid errors in charge entry,…

In these uncertain times, given all the changing rules regarding the filing, collection, and processing of claims by insurance carriers, doctors do encounter financial burdens. The most frequently asked questions. Am I collecting the highest possible amount? How can I know that I collect as much as possible? How can I increase my income? Perhaps…

Outsourcing as a concept within a medical organization is the transfer of part of the functions of servicing the activities of a medical institution to another company specializing in the relevant field based on an agreement. Outsourcing allows managers and staff to focus on the essential functions that they perform, primarily as medical specialists. Those…

Many business owners today need additional interactive “assistants” to automate work processes. Mobile application development – the creation of algorithms that are used to write software for wireless devices such as phones or tablets. How to choose a development company, what to look for in the first place? Mobile app development has been and remains…

Currently, most organizations strive to sell their goods or services with immediate payment and, as practice shows, sometimes they have to work through loans, that is, deferred payment. This leads to the inevitable occurrence of receivables, which today exists in the settlement system. Therefore, it is on the part of the organization that the initial…

Medical claim denials have risen, and they are affecting not only the hospitals but only also the physicians. This comes as an expense to the healthcare industry, whereby sometimes, the claim is denied, which is a loss. They lose revenue, which could have been used for the daily running of the activities. Therefore, there is…

In many organizations, an essential component is the data entry process. It entails the creation of actual data of the company. And in that case, the data to be processed should be free from errors at all costs and in an approved form. Every firm at all times aims at perfectly undertaking daily activities. The…

Have you thought about authorization before outsourcing? Outsourcing the pre-approval process will be very profitable for your business! Outsourcing prior authorization services are essential for the profitability of any business. A critical step to success is to identify benefits for the patient and consider specific medical procedures before performing the service. Reimbursement for many emergency…

The medical billing companies are different from the medical coding companies in many ways.  In medical billing, you use proprietary data software to enter data into a system, while in medical coding, you have to get in touch with healthcare professionals such as doctors and nurses. The main aim here is to classify the services…

Nowadays, when there are so many companies and individuals around the world who are developing apps you need to be at your best at all times. You need to make sure that your app is performing well. Otherwise, you could lose your users because of 1 bad experience. There are many other reasons why your…

In every business or organization, it is always big stress if the payments are not received on time or are inaccurate. But when there are proficient ways and systems to guide you, there will be no time, money or energy wasted from your side. The best solution is to outsource your accounts receivables that are…

It goes without saying that every organisation should always focus on their core competencies and outsource all the processes which are time-consuming and up costing them their profits and also a lot of manual labour and crucial resources which can otherwise be used in a much better manner. Read on to know why you should…

Denial of medical claims has been the biggest concern for physicians, doctors & other healthcare professionals. Recurring denials or increase in denials lead to operational losses which are difficult and sometimes impossible to recover. Denials fall into two big buckets: hard and soft. Hard denials cannot be reversed or corrected, and result in lost or…

The AMA (American Medical Association) recently stated that the rise in claims processing errors is causing unnecessary costs for the healthcare industry. Not all of the factors that influence claims payment are within your control, but you can take steps to lessen at least some of the frustration and unnecessary expense associated with claims delays…

Medical billing involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. Essentially, medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services…

ARTIFICIAL INTELLIGENCE TODAY Over the recent years, a lot of people have been discussing a specific term comprehensively and that term is AI or Artificial Intelligence. Even Hollywood has been using this topic to make movies since years. Now the question arises what exactly is Artificial Intelligence? “Artificial Intelligence is a branch of computer science…

Medical transcription is key in medical practice. Accurate and timely transcriptions are an absolute must. Physicians need to be certain that their vocal dictations will be accurately transcribed into well-polished, written documents. It doesn’t matter if the organization is a start-up or owned by solo proprietor or a large one, the importance and value of…

EMR stands for Electronic medical record, which is the systematized collection of patient health information and a digital equivalent of paper records. The EMR represents a medical record within a single facility, such as a doctor’s office or a clinic. EMRs typically contain general information such as treatment and medical history about a patient as it…

What is Prior Authorization? Prior authorization is an important element of medical billing and RCM. It is basically a health plan cost-control process requiring providers to obtain approval before performing a service to qualify for payment. Health insurers frequently require prior authorization for pharmaceuticals, durable medical equipment and medical services.  It is one of the…

About RPA Robotic Process Automation or RPA is the technology that allows anyone today to configure computer software, or a “robot” to emulate and integrate the actions of a human interacting within digital systems to execute a business process. RPA is capable of automating activities (by creating software agents) that once required human judgment. This…

Outsourcing is a concept people get fired up about. Some people love it; others hate it. It seems as though nothing divides a room full of business professionals faster than the idea of sending some services out of house. Although some people will argue against it until they’re blue in the face, outsourcing is incredibly…

What is RCM? Revenue-cycle management (RCM) can be defined as the process of handling claims, processing payment and generating revenue in the healthcare industry. Itis about how an organization handles finances and processes associated withdifferent steps of patient care, beginning from the time when a patient makesan appointment to seek medical services and endingafter all…

Outsourcing is a concept people get fired up about. Some people love it; others hate it. It seems as though nothing divides a room full of business professionals faster than the idea of sending some services out of house. Outsourcing is the practice of using outside firms to handle work normally performed within acompany and is…