Outsourcing Medical Billing and coding

  Did you know that automating verification practices will lead to annual savings of nearly 8.5 billion dollars for healthcare providers, according to the Council for Affordable Quality Healthcare (CAQH)? Furthermore, healthcare claim denials related to eligibility issues amount to over 75% of such denials, according to American Medical Association (AMA) data. A claim qualifies as clean when it gets submitted correctly the first time. In fact, every hospital requires these claims to maintain financial consistency, together with operational efficiency. Therefore, a hospital’s ability to achieve successful claims depends on completing patient eligibility checks and insurance verification before submission. What Is Patient Eligibility and Insurance Verification? Patient eligibility and insurance verification is the process of confirming a patient’s active insurance coverage and the specific benefits included under their policy before delivering medical services. This verificat...

  The research conducted by HFMA found that more than 65% of healthcare organizations are dealing with financial challenges due to their poor revenue cycle operations. Further, the importance of optimizing  Revenue Cycle Management (RCM)  has increased as the claim denial rates stand at 10% and administrative costs continue with their upward trend. Therefore, offshore medical billing companies provide strategic support while delivering accurate solutions, and effective compliance measures to simplify complex billing processes. Let’s see how: 13 Steps of RCM for Optimization: 1. Patient Pre-registration The RCM process starts by collecting patient demographics, insurance details, and medical history as part of accurate pre-registration. Offshore teams effectively enhance data processing by checking information while reducing mistakes so it can integrate into practice management systems. The process of pre-registration data entry creates organized claims which simplify...

  Credentialing operates as an essential cornerstone within the healthcare industry as it only authorizes skilled healthcare professionals to offer patient care. In an increasingly complex healthcare environment, the importance of credentialing cannot be overstated. The National Association of Medical Staff Services (NAMSS) indicates that provider onboarding delays due to credentialing issues affect more than 90% of healthcare providers. Hospitals allocate over $2 billion per year to handle credentialing-related administrative tasks based on research conducted by the Council for Affordable Quality Healthcare ( CAQH ). Despite its importance, hospitals encounter multiple challenges with their credentialing procedure as they deal with prolonged processing times, inconsistent procedures, and regulatory compliance issues. This blog provides a comprehensive guide to  credentialing services for healthcare providers . What is Healthcare Provider Credentialing? Hospital admini...