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Revenue Cycle Management

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Claims Creation and Scrubbing: What They Are and How to Get Them Right

Proper charge capture enables you to create an accurate claim that has a better likelihood of reimbursement. The next step to create the claim itself and scrub that claim to make sure it is clean and error free.

Misunderstanding the Cause of These Denials May Cost Your Practice $$$

Want to understand and protect your practice from a significant but lesser-known cause of claim denials? In this blog, we suggest some solutions.

Claims Submission: Make it Clean and Save Time

Having a high clean claims rate indicates that your practice's processes for billing and managing claims are sound. Hear how ambulatory healthcare professionals successfully implemented RCM solutions and claims processing software.

To Run a Financially Healthy Practice, Get to Know These Five KPIs

By understanding these 5 key performance indicators (KPIs), you can gain valuable insights into your practice's revenue cycle.

What is revenue cycle management in healthcare?

In healthcare, an effective RCM process ensures that the full interaction with a patient from initial inquiry through final payment is effectively managed.

Turning Over Your Revenue Rocks: 4 Overlooked Ways Behavioral Health Organizations Can Boost Revenue

Optimize behavioral health revenue cycle management with centralized billing and AI-assisted coding. Enhance patient engagement for improved outcomes. Get started now!

What is Payer Adjudication: Tips to Improve Your Medical Claims Process

Our last blog post on the revenue cycle journey looked at clearinghouse edits. The next stop in the medical claims process is payer adjudication.

How to Capture Charges for Faster, More Accurate Reimbursement

The previous blog in this series explored how to effectively capture patient’s information at the front desk. The next topic is charge capture—the process that physicians, other healthcare providers, and medical office staff use to record information about services provided. Once recorded, this information is translated into a claim and sent to third-party payers for reimbursement.

The Self-Insured Healthcare Market – What You Don’t Know Can Hurt You

According to a 2009 CDC report, in the 1990s there were approximately 175 million Americans covered by commercial insurance with about 40 percent (70 million) in self-insured plans. Compare that to a 2019 report showing that commercial coverage was down to 154 million, but the number of people participating in self-insured plans had increased to 92 million, constituting 60 percent of the commercial total.

Leverage Technology and Services to Compensate for Gaps at Your Eye Care Practice

Enhance Your Eye Care Practice's Profitability with NextGen® RCM Services! Automate billing processes, gain expert insights, & save time.

Align People, Process, and Technology for Successful RCM

Strong revenue cycle management matters in healthcare. To achieve effective RCM, medical practices must balance people, process, and technology.

How to Make Sure Your Claim Isn't Denied by Your Clearinghouse

As we continue along the revenue cycle journey, it's now your last chance to prevent a denial before you submit your claim for payment. Understanding how the clearinghouse works and how it fits into the claims process helps ensure your claim isn’t rejected later by insurance payers.

Reporting & Analytics: How to Monitor the Health of Your Practice to Ensure Financial Stability

Last step in the claims process. Assessing the data in the available reports and analytics to effectively monitor the health of your practice. This can ensure financial stability and freedom for your practice long into the future.

The Revenue Cycle Journey: Ideas and Tips to Improve Your Medical Billing Process

The revenue cycle journey affects every aspect of your practice, including patient satisfaction, provider experience, and financial and clinical outcomes. In this upcoming blog series, we will explore all areas of this journey.

Getting Paid Isn't Everything

Once money starts flowing in, medical practices often neglect to consider the financial impact of contracting and credentialing.

Tough Decisions About Managing the Revenue Cycle

To keep the revenue cycle process inhouse or outsource to a vendor—that is the question. At one time or another, most medical practices—especially those that experience growth—come to a crossroads about the best way to manage billing and finances.

Five Reasons Health Plans Make Payment Errors

When the health plan says a claim is lost or they send an incorrect payment, providers often feel like victims of an evil plot. In trying to decipher health plan motives, it may be helpful to consider the scale and complexity of their operations.

Communication: The Heart of an Effective Patient Pay Strategy

More and more balances fall to patient deductibles, leaving less of what's owed to be paid by insurance. This trend holds regardless of practice size or specialty.

What Does Revenue Integrity Mean to Your Healthcare Practice?

The phrase revenue integrity is trending in the world of healthcare and medical practice administration. How can the concept help your practice?

How real-time eligibility verification can enhance practice efficiency

With the health insurance industry in transition, the need for real-time medical eligibility verification has never been greater. With an EHR/EMR platform, featuring a medical eligibility verification system, you get real-time eligibility and benefits, the ability to verify Medicare, as well as accurate co-payment, co-insurance and deductible data.

Claims Follow-Up and Denials Management: How to Better Manage Medical Claims Denials

The focus of this blog will be on following up on denials to help maximize revenue earned by the practice. Most practices meet timely filing standards for the initial submission of a claim but be aware there are also deadlines for reworking and appealing denials.

What is Payer Remittance: How to Better Manage Payments and Keep Track of Denied Claims

In this blog, we are going to cover the process of payer remittance and helpful tips to manage payments and keep track of denied claims.