Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Switching Clearinghouses After the Outage: How to Do It, and When Not To
Change Healthcare began reconnecting its claims network the week of March 18, and practices are now deciding whether to switch back, stay with a new vendor or run both. Here is what a clean clearinghouse migration involves, the enrollment steps that take the longest, and the cases where switching is the wrong call.
The December Revenue Cycle Checklist: Timely Filing, Holidays and January Resets
December is when unworked claims expire and January problems are created. Here is the checklist we run with practices every year: timely filing sweeps, payer holiday cutoffs, the deductible reset conversation, re-verifying Medicaid patients after a year of unwinding, and the IDR portal reopening.
Why Total AR Tells You Almost Nothing: Reading AR Aging by Payer
A single days-in-AR figure hides more than it shows. Here is how to build and read an AR aging report by payer class, the benchmarks that apply to each bucket, how to separate payer slowness from practice slowness, and the weekly worklist that comes out of it.
Billing Staffing Shortages in 2023: Running the Revenue Cycle With Fewer People
MGMA polling this spring found coders and billers are the hardest revenue cycle roles to fill, and turnover in business operations staff topped 33% last year. Here is how the practices coping best are cutting rework, automating the repetitive checks, cross-training, and deciding what to send out.
Eligibility Checks After the PHE: Rechecking Medicaid Coverage at Every Visit
Six weeks into the Medicaid unwinding, the first states have posted termination numbers and most people losing coverage are losing it for paperwork reasons. Here is how the 271 response shows what changed, the pre-visit and day-of checks that catch it, and what to do with claims for patients who are later reinstated.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.