Denial Management Process: Introduction Effective denial management is vital for healthcare providers to maintain financial stability and ensure that services rendered to patients are appropriately reimbursed. Denials can occur due to various reasons, such as coding errors, missing documentation, inaccurate patient information, and failure to meet payer-specific guidelines. By establishing a structured denial management process, […]
Medical coding is the process of assigning numerical or alphanumeric codes to medical diagnoses, procedures, and treatments for the purpose of billing and reimbursement from insurance companies or government programs. These codes are used to identify medical services and their associated costs, as well as to track and analyze healthcare data for research and quality […]
Negotiating a fee schedule contract with a health insurance provider in the USA can be a complex process, but here are some general steps that you can follow: Research and Prepare: Gather information about the health insurance provider, including their current fee schedules, reimbursement rates, and other contract terms. Also, prepare your own data on […]
The Merit-based Incentive Payment System (MIPS) is a program that is designed to incentivize healthcare providers to provide high-quality care to their patients. The MIPS program was established as part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which aimed to shift Medicare reimbursement from a fee-for-service model to a value-based care […]
The process of billing claims and reimbursement is called “Revenue Cycle”.
