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Monthly Archives: November 2022

Provider’s Enrollment and Credentialing

Provider’s Enrollment and Credentialing

What’s the Difference between these two? Credentialing Explained: Validating a healthcare provider in a private health plan and the approval to join the network is credentialing Enrollment Explained: While enrollment represents to the process of requesting participation in a health insurance network as a provider. Payor Enrollment, Credentialing Bringing new healthcare providers on board is […]

Hierarchical Condition Categories-HCCs

Hierarchical Condition Categories-HCCs

HCCs (Hierarchical Condition Categories) aren’t a new idea, but they didn’t attract wide interest until CMS began shifting more payment toward value-based programs, particularly MACRA, which affects clinician reimbursement. Organizations are rapidly shifting towards it. HCCs Explained: So there has been renewed interest in the concept. And it makes sense – without solid basic knowledge […]

Emergency Room Medical Billing

Emergency Room Medical Billing

Due to the growing number of payers, it has been noted that payment collection for emergency department and urgent care providers is getting more difficult. As a result, it appears that the breadth of the capacity of payment charges is decreasing. Particularly when elements like reimbursement, payer mix, and others are important to enhance the […]

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