Telehealth is a technology-driven approach that emphasizes the remote provision of health care and other health-related activities. Clinicians, patients, and providers are all involved in the communication and education that is involved. Although it does not increase the number of providers, it may help to enhance the efficacy and broaden the reach of existing personnel. Telehealth is not a service, but something much more general, like the name of operating health care services.

To overcome workforce and access barriers, telehealth billing offers promise in reducing health disparities of underserved populations and older adults while saving patients the costs or inconvenience of missed work time, transportation (e.g., bus fare), or childcare expenses. With telehealth, patients in isolated locations also get the option of interacting with multiple doctors, which makes it convenient to seek expert consultations locally. For example, they may participate in video visits with providers to manage acute and chronic needs.

The advantages of monitoring patients remotely or through telehealth

Using technology advancements to gather patient data outside of conventional healthcare delivery locations, remote patient monitoring, also known as RPM or telehealth, is a healthcare delivery strategy that benefits patients, medical professionals, caregivers, and the healthcare system as a whole.

The following are the key benefits, which range from cost reductions to reducing the spread of COVID-19, increased patient-provider point-of-care availability, and patients’ self-management. 

Leveraging data to guide clinical decisions, helps make better sense of health for patients and makes them adhere to their treatment plans more efficiently.

Reduce the cost of healthcare to both payers and providers.

Increases net patient revenue

Improves the efficiency of tasks and reduces patient costs

Improves healthcare accessibility

It makes clinical staff more efficient, engages patients and helps with a staffing crunch.

Helps avoid infection and hospital-acquired infections

Increases caregiver engagement and attachment to the care they deliver

Enhances satisfaction and experience for their patients

Better retention & more referred business

Builds rapport between the healthcare professional and patient

Obstacles to the provision of rural healthcare

Living in remote, rural areas is a disheartening experience, as rural healthcare institutions frequently lack the financial resources to hire highly skilled healthcare professionals and acquire more commonly used instruments found in metropolitan healthcare facilities.

In order to improve patient care in rural areas, nurse practitioners must address the following obstacles and educate patients on the most effective methods for maintaining their health.

Scarcity of healthcare professionals

Insufficient understanding of health issues

Privacy and social stigma

Healthcare coverage that is inadequate or non-existent

Telehealth is an exceptional method for establishing a practice in remote regions.

Although it is currently at its most advanced stage of development, telehealth has been expanding for half a century, and this expansion has not been limited to the mere act of videoconferencing with an out-of-town patient. To broaden healthcare coverage to rural regions and astronauts, government authorities and corporate entities have made investments in telemedicine.

Decreased readmissions: The key to keeping readmissions as low as possible is prevention. This means that telehealth could be utilized for follow-up appointments, where patients might have to meet with their physicians remotely without any unexpected medical interventions. It is what stops events from evolving into more dangerous situations. Patients will also have difficulty addressing their post-care at home. Yet, HIPAA-compliant consultation platforms allow nurses and physicians to monitor post-discharge care for released patients, which in turn, when a patient issues an aftercare, prevents them from showing up at the hospital again or relapsing symptoms.

Access the underserved and distant populations

Persons who have resided and worked in rural areas are required to travel a considerable distance to obtain specialized treatment, and they are often unable to obtain immediate care in severe situations. Clinical exposure is significantly restricted for individuals residing in impoverished areas, as they frequently lack reliable transportation. Patients residing in rural areas may benefit from the ability to consult with physicians virtually from their homes, which could lead to a high level of patient satisfaction. Telehealth providers have facilitated the advancement of hospitals and clinics in remote regions. Telemedicine has adopted the responsibility of providing a dependable source of treatment to underprivileged and chronically ill individuals.

Medication management can be enhanced through the use of telehealth

In both urban and rural areas, telehealth provides a variety of essential services to patients. It encompasses the provision of assistance with substance management. Approximately $310 billion in unnecessary spending and $100 billion in preventable hospitalizations are attributed to the fact that half of the individuals in the United States who are taking medications are not adhering to their physicians’ recommendations. The matter is particularly severe for those who are taking numerous medications: the healthcare expense is accounted for by the top 1 percent of high-acuity chronic illness patients, who account for 23 percent of the total, or nearly $107,000 per patient. The healthcare authorities are optimistic that a digital health platform that monitors medication adherence at home and provides care professionals with information about the patients would reduce these expenses and improve the overall health of these patients.

With sufficient internet connectivity and video capabilities, comprehensive medication management (CMM) can be implemented through telehealth. It is possible to detect nonverbal cues through telemedicine with the assistance of concentration and experience. Their features and body language are still visible. You can identify when a patient is uneasy or disturbed by any stimulus. If their treatment objectives are not being met, you may observe this. Patients may begin to squirm in their chairs when they are uncomfortable, which is one of the few instances of non-verbal indications. Certain methodologies guarantee that you obtain the most precise responses to your inquiries.

Open-ended questions should be administered to patients in lieu of fundamental “yes” or “no” inquiries. For instance, soliciting the patient’s medication list from both a nurse and a patient may result in conflicting responses that necessitate resolution. It is imperative to ascertain whether the patient is authentically consuming the medications listed on the pharmaceutical list. You can ask how many missed doses the patient has had in the last month, and their first answer to this will probably not be true. Then you can ask about how many occupied spots they had last week—two weeks or so as well—and how many slots lay vacant. Lastly, if they are not taking the dose as prescribed, you will want to ask about specific adverse events and provide this list.

Accurate identification of the challenges a patient encounters when taking their medications is required to work with them on devising an effective management plan that not only controls his/her disease but also prevents adverse effects and inefficacy due to potential interactions. It must be able to read their body language, which is possible when video conversations are present, so CMM becomes a service that can be delivered via telehealth.

Is there a way to overcome these obstacles?

Medication adherence is the term used to describe the extent to which individuals adhere to the prescription instructions provided by their healthcare provider for drug administration. It involves adhering to the prescribed dosage of medication, remembering to complete prescriptions, and adhering to instructions precisely.

Place a high value on medication education and review.

Ensure that the patient is informed of all the benefits (as well as any potential adverse effects) of taking the medication as prescribed prior to prescribing it. To foster cooperation and transparency, it is advantageous to involve the patient’s relatives or attendants in the planning process whenever feasible. Telehealth is an excellent approach to promptly and safely involving patients, caregivers, and physicians in this process, thereby guaranteeing timely evaluation and ongoing education.

Utilize technology

Medical providers may utilize technology to remind patients of their lifestyle regimens and prescriptions in order to encourage adherence. By utilizing telehealth, it is possible to continuously communicate with patients in order to engage them proactively in the event that they have questions about their medications, neglect to renew their prescriptions, or skip dosages. Telehealth billing engagement, including medication reminder applications, virtual visits, and remote patient monitoring equipment, has the potential to alter patient behavior and increase their satisfaction.

Patients now play a significant role in payment, and the successful introduction of automation and AI into medical billing has significantly.

Patients now play a significant role in payment, and the successful introduction of automation and AI into medical billing industry trends has significantly increased operational efficiencies for providers. Simultaneously, this shift from fee-for-service to value-based care tools has led to an increase in the number of outsourced service models that inpatients are primarily responsible for. These changes need to be made even more to benefit your revenue cycle.

Billing is an area that consistently needs help for most medical offices. Over the last few years, there has been an exponential rise in so-called medical costs, and many patients naturally expect higher levels of transparency or alternatives when it comes to payments. As a medical provider, you may be stuck in the middle of how to ensure patients receive necessary medication or treatment while still paying conveniently on top of everything else, taking care of your remaining work overload while also making sure your efforts are compensated. The positive news is that there are a number of universal billing trends that simplify the entire process.

Artificial Intelligence and Automation in Medical Billing

Medical billing practices are changing through AI and automation in 2025, and the demand for AI-driven billing software will increase to simplify administrative processes, minimize errors and pay faster. In this way, accounting staff can focus on more important parts of revenue cycle management, such as claims processing and denial resolution, with a greater degree of accuracy and efficiency thanks to AI-powered solutions.

Telehealth Billing and Reimbursement

Telehealth services have been in development, and COVID-19 has made some of them official, with research experts identifying telehealth as a “default” work model that will be widely accepted after 2025. As telemedicine continues to expand, medical accounting procedures will have to adapt to these emerging service models. For practitioners, this could mean appropriate documentation and billing for services provided via telehealth to ensure their compensation is the same as if they were doing an in-office visit. In 2025, medical invoicing management will be only one of the many aspects that must be skillfully navigated to successfully work with government and NHS legislation surrounding telemedicine payments.

Value-based Medicine and Alternative Reimbursement Systems

In 2025, we will finally begin to see momentum in value-based care agreements that place patient outcomes ahead of the quantity of services delivered. With healthcare facilities moving from the traditional fee-for-service model, medical accounting will also be required to comply with value-based care concepts. This transformation will require billing and coding that adequately reflect the quality and value of care delivered, incentivizing healthcare providers to focus on population health management and prevention.

Data Privacy and Compliance

Poor security opens healthcare organizations to legal liability as well as financial losses related to breaches and cyberattacks. Medical billing companies will emphasize data security measures more than any other feature in 2025, as the industry is under an immense burden to keep patient-sensitive information out of unauthorized access. Adherence to data privacy laws such as HIPAA will remain a top concern in order to avoid large fines and maintain patient trust.

The year 2025 will turn out to be a significant milestone in the history of medical invoicing practices. Medical billing firms will have to get proactive and adapt themselves to the burgeoning AI/Automation world, telemedicine revolution, valuation-based care explosion, medical necessity close-in hold of scrutiny mechanisms, along with complying data security and compliance positivity. Keeping an eye on these trends can help in better revenue cycle management and, therefore, increased patient care and healthcare outcomes. Prosperity in the ever-changing medical billing industry with accuracy, regulatory conformance and technology.

MIPS Reporting with Registry vs. EHR

Registry and EHR are now a few of the precious alternatives to pick from in terms of your MIPS reporting process. You need to analyze all the pros and cons of each one in depth so that it adjusts better to your requirements.

Outsourcing vs. In-house Billing

Getting your billing outsourced is one of the best ways to support a small or newly established medical practice. While it may look like an additional cost, billing is one of the most important and time-consuming parts of a new company.

Why Velan HCS?

As a veteran medical billing service provider with more than 15 years of experience in the field, our legacy and established expertise introduce us to a host of intricacies present within this space. Every minor variation that will probably affect your claims is recorded.

If you like what sounds more intriguing to you, visit our website for further information or contact us by mail at any time. We would be glad to help!

Conclusion

After 2025, three trends will transform the practice of medical invoicing. These include the use of artificial intelligence (AI) to enhance accuracy and efficiency, blockchain technology to enhance security and transparency, as well as an increased focus on telemedicine and virtual care. Furthermore, the move from ICD-10 to ICD-11, the evolution of advanced invoice tools, and the increasing adoption of hosted (cloud) platforms will generate major business opportunities. These trends are not going away any time soon, and in order to survive within the healthcare industry while promoting its overall growth, particularly when it comes to improving patient experiences and streamlining billing processes for all concerned parties, healthcare billing providers must stay abreast.

“Denial” is hardly ever a beneficial word to come across. Especially when you’re at the receiving end of it, be it your visa application, loan application, or any application awaiting approval. And this word takes on a whole new avatar when it comes to revenue cycle management. Besides just being a metric to measure the success of a firm, it also directly reflects the financial success of the firm.

Claims are highly sensitive documents that require scrupulous scrutiny before submission. It’s almost like walking on thin ice. Claims are denied when they don’t meet a set of required criteria of the insurance company or carrier, thus leading to the rejection of funds to cover the services provided by the healthcare provider. The set of requisite criteria may vary from one insurance company to another. In essence, they are all similar but not exactly the same. So, an accurately populated template that works with one carrier may not necessarily work with another. “Clean claims” are those that successfully navigate the approval process and receive the green stamp. Clean claims are a pleasure for the provider. Healthcare firms dream of achieving and holding a 100% clean claims rate—an aspiration that isn’t even remotely as easy as it may sound.

15 Solutions for Claim Denial Management Services to Enhance Cash Flow

How can you maintain a denial rate below 5% and increase unhealthy cash flow? The main lesson is to avoid delaying. Address the issue(s) immediately, and review, rectify, and resubmit denials within the next week.

The following are common reasons for claim denial management services, along with solutions that can help enhance your cash flow:

Someone submitted a claim twice for the same service or procedure. Before resubmitting an unpaid claim, consult with the insurance payer, who may be processing it. Determine the reason for the claim’s nonpayment, or whether the clearinghouse rejected it.

The patient is ineligible for services due to the expiration of their health plan coverage. It is imperative to verify the patient’s insurance coverage at the time of check-in. To guarantee that you have the correct claim filing address and critical information, copy both sides of the card.

The physician does not belong to the insurance network. Ensure that the insurance payer has authorized the provider. Submit and monitor provider credentialing applications in accordance with the insurance plan’s specifications. To ensure that providers enroll in-network when enrollment opens, maintain regular communication with insurance payers.

Invalid or missing patient demographics and insurance information. At all times, confirm the spelling of the patient’s name, date of birth, responsible party, vision, and medical plan numbers. A single required field, a transposed number, or a letter will trigger a denial.

The benefit exceeds the permissible number of services or visits. Provide the insurance payer with confirmation of the patient’s eligibility. Within a calendar year, numerous insurance companies provide coverage for only a specified number of visits or services.

The primary complaint was missing. When documenting the chief complaint, provide a succinct explanation of the problem or laboratory test. If you find yourself under audit, this will be beneficial. A missing chief complaint, based on inaccurate levels of care, may result in a claim denial.

A prior authorization number is necessary for the claim. A critical initial phase in the RCM process is the verification of a patient’s insurance benefits. Whenever possible, obtain authorizations from the insurance payer prior to the patient’s visit to your office. Before submitting the claim, make sure to include the prior authorization number.

The referring physician and referral information are absent. Verify whether a referral (written order) from the patient’s primary care provider is required, and that the referral number on the claim is accurate. This will ensure continuity of care and establish a transparent patient treatment record.

The modifier is invalid, or the claim lacks a code or modifier. The HCPCS or CPT® codes incorporate modifiers to specify the reason for a physician’s provision of a specific service or procedure. Not all modifiers are compatible with all HCPCS or CPT codes. Payers will deny your claim if even one procedure code is inconsistent with the modifier or if a modifier is missing for the applicable service date. For instance, Modifier 25 is among the most frequently misused modifiers. When performing both a procedure and a substantially unrelated and separately identifiable evaluation and management (E/M) service during the same session or on the same day, use modifier 25. When an E/M service leads to a surgical decision, we should apply modifier 57 instead of modifier 25.E/M services. If tests are required due to two separately identifiable conditions, it may be possible to link the appropriate diagnosis code to each CPT code and add modifier 59 to the second procedure, depending on the local policy. Check out our blog, “How (and How Not) to Use Common Medical Billing Modifiers,” for additional billing guidelines and to identify potential red flags when using common modifiers.

The billing should have been separate, not combined. Bundling may be necessary for certain services, such as laboratory profiles that include multiple tests or an all-inclusive rate that covers the minor procedure as well as the pre – and post-procedure visits.

The performed procedure does not align with the place of service (POS). Revise the CPT® code or place of service code, and resubmit the claim. Make sure the point of service (POS) aligns with either the face-to-face service provider’s location or the technical service provider’s location for non-face-to-face services like diagnostic test interpretation.

The plan’s benefits do not cover the service or make it medically necessary. Consult the insurance payer’s website and your Local Coverage Determinations (LCD) policies for a list of covered diagnoses.

The claim does not include postoperative care dates. Verify the postoperative dates and incorporate the omitted dates into the claim form. You need these dates to ascertain the length of postoperative care the patient received. The dates also confirm that care is included in the global surgical program. Furthermore, it may be necessary to submit a new claim form or modify the original claim form in accordance with the insurance plan’s policies. In order to avert any additional delays or denials, consult with your insurance provider.

The National Drug Code (NDC) identifier is absent. The NCD is a distinctive medication identifier that furnishes critical information, including the label, product, and package size. It is crucial to incorporate the NDC ID into medical claims. The ID guarantees precise accounting and reimbursement by distinguishing between drugs that may share the same Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes.

The deadline for filing has elapsed. Pay close attention to the time frame that is permissible. Each insurance provider establishes its policies. Occasionally, the deadline to submit a claim is as short as 30–90 days from the date of service. If not, the insurance company will reject the claim, making it impossible to bill the patient or file an appeal.

Top 5 Most Common Errors That Stand in the Way of a Clean Claim

Medical Coding Accuracy: Incorrect CPT codes can lead to immediate rejection of the claim. The CPT codes translate and codify the procedures involved and help insurance companies tie the knots together. The recent transition from ICD-9 to ICD-10 coding services further complicates this process.

Demographic Accuracy: This is collecting information about the patient at the front desk. As simple as it may sound, you’ll be surprised to see how things can sometimes go amiss. From capturing a patient’s name to getting every digit of the insurance number right, it is all sleet and thin ice.

Eligibility Assessment: It is sensible to first find out if a patient is eligible for insurance or not. This can wipe out a tremendous amount of rigmarole.

Claim Duplication: Claims are, at times, resubmitted. Submitting the same claim twice would result in the rejection of both claims. So, a potential clean claim can get rejected because of a talking clone.

Incorrect POS: There exists a unique 2-digit code for hospitals, nursing homes, emergency rooms, etc. This unique code must match the respective CPT code to avoid rejection on the grounds of an incorrect POS.

Best Practices to Reduce Claim Rejections

Proofreading and Re-proofreading: Speed can at times be an impediment to accuracy and precision. Most typographic errors are retained due to the lack of a third-party review. Having a second pair of eyes review the work can highlight certain errors you may be blind to. Proofreading it once and having it run by another person for a second opinion can help. It may take a few extra minutes, but what it could achieve would save a lot of repetitions in the long run.

Demographic Data from the Front Desk: The responsibility of this task will heavily rely on the front desk. After the capture and collection of accurate demographics, the transmission of the data to the billing department will be highly critical. If anything goes amiss here, the rest of the process that follows would be a complete waste of time and resources. It would be ideal for billing departments to work closely with the front desk and cross-check the details at each patient visit.

Verification of Eligibility: This is yet another important link to overarching denial management. Ideally, this is where we assess a patient’s eligibility. Normally, the billing software would verify this during the patient’s visit.

Insurance Company Validation: As mentioned earlier, this is one of those junctures where things can go awry on multiple accounts. A patient may have multiple insurances, and sending a claim to the wrong insurance will result in immediate rejection. So, a potential clean claim can get rejected because of a talking clone.

Insurance Requirements: Staying abreast of regulatory updates and information pertaining to the industry would be obligatory. Even minor changes can disrupt the entire process and collapse the system. Besides the regulatory changes in the industry, even carriers are known to make changes at times. So, it would make sense to stay on high vigil and be sensitive to any news related to the industry or insurance carriers.

Velan Healthcare Service: A Roadmap to Healthy Cash Flow and Successful Revenue Cycle Management

On the bright side, for firms that lack the technology and expertise in denial management services, there is always the option of outsourcing healthcare denial management services. Outsourcing your medical billing to denial management Services, such as Velan Healthcare Services, is an excellent option. With over a decade of experience and expertise in the domain, we’ve seen and taken on almost every possible challenge that comes along the way. Equipped with redundant infrastructure and working round the clock, we take it upon ourselves to ensure the delivery of not just results but also values.

The revenue cycle is the process of billing and collecting payments for healthcare services. It is a complex and time-consuming process, and it can be difficult for healthcare organizations to manage it effectively in-house. This is where revenue cycle outsourcing (RCO) can come in.

RCO is the practice of hiring a third-party company to manage all or part of the revenue cycle. This can free healthcare organizations to focus on other priorities, such as patient care.

There are numerous benefits associated with RCO, including:

Improved efficiency: RCO companies have the expertise and experience to manage the revenue cycle more efficiently than most healthcare organizations.

Reduced costs: RCO companies can often provide services at a lower cost than healthcare organizations can provide them in-house.

Increased cash flow: RCO companies can help healthcare organizations collect payments faster, which can improve cash flow.

Improved compliance: RCO companies are experts in healthcare regulations, which can help healthcare organizations avoid compliance problems.

However, there are also some risks associated with RCO, including:

Loss of control: When healthcare organizations outsource their revenue cycle, they lose some control over the process. This can be a problem if the RCO company does not meet the organization’s expectations.

Data security: Healthcare organizations need to be careful about the security of their data when they outsource their revenue cycle. RCO companies should have strong data security measures in place.

Communication problems: Communication problems can sometimes arise between healthcare organizations and RCO companies. This may lead to errors and delays.

Overall, RCO can be a good option for healthcare organizations that are looking to improve the efficiency and effectiveness of their revenue cycle. Before making a choice, it’s crucial to carefully balance the risks and advantages.

In-House vs. Outsourced Revenue Cycle Management

There are two main ways to manage the revenue cycle: in-house and outsourced. Every technique has its own advantages and disadvantages.

In-House Revenue Cycle Management

With in-house revenue cycle management, the healthcare organization handles all aspects of the process, from billing to collections. This gives the organization more control over the process, but it can also be more time-consuming and expensive.

Outsourced Revenue Cycle Management

With outsourced revenue cycle management, a third-party company handles all or part of the revenue cycle. This frees up the healthcare organization to focus on other priorities, but it also means losing some control over the process.

Which Approach is Right for You?

Depending on your unique demands and circumstances, you can choose the appropriate strategy. If you have the resources and expertise to manage the revenue cycle in-house, it may be the best option for you. However, if you are looking for a more efficient and cost-effective solution, outsourced revenue cycle management may be a better choice.

Before making a decision, consider the following:

The organization’s size and complexity

Your budget

Your level of expertise in revenue cycle management

Your willingness to give up some control over the process

If you are still unsure which approach is right for you, it is a beneficial idea to consult with a revenue cycle management expert. They can assist you in determining your needs and creating a strategy that is appropriate for you.

How to Choose a Revenue Cycle Outsourcing Company

If you decide to outsource your revenue cycle, it is important to choose a reputable company. Here are some tips for choosing an RCO company:

Get referrals from other healthcare organizations.

Do your research and compare different companies.

Verify the company’s expertise in your particular industry.

Get everything in writing, including the contract terms and conditions.

By following these tips, you can choose an RCO company that will help you improve the efficiency and effectiveness of your revenue cycle.

The ideal partner can hasten your progress and help you achieve long-term financial success. Outsourcing revenue cycle processes can be a strategic instrument to underpin the transformation and assist you in achieving elusive profits.

Every day, we hear disturbing allegations of data mishandling incidents, ranging from data violations to stolen information and personal records. It is these very troubling allegations of data mishandling that we see nearly every day.

Mishandled data security in healthcare field comes with a unique set of challenging allegations. You might have come across the 2014 hack against Community Health Systems, which resulted in stolen information that affected nearly 4.5 million people. Data safety is becoming an increasing worry for healthcare data security organizations and for an excellent reason.

We are all aware that healthcare organizations create and gain information at record speed. According to a study, big data for US healthcare will reach 1024 gigabytes in the coming years.

As the volume of healthcare data grows, it inevitably puts data privacy and safety at risk. Data privacy and security violations not only spoil your organization’s reputation and compromise patient relationships, but they also result in major expenditures.

How secure is your healthcare data?

For hackers and cybercriminals, patient data is a valuable asset. Medical records contain a plethora of personal information, such as financial details, social security numbers, and medical histories. Consequently, it is essential to evaluate the security of healthcare data and implement proactive measures to ensure its effective protection.

The Significance of Healthcare Data Security

There are numerous compelling reasons why it is imperative to guarantee the security of healthcare data. We must prioritize patient privacy to preserve trust and adhere to ethical standards. Patients trust healthcare providers with their most private information, so any breach can damage their reputation and well-being. Additionally, identity theft, insurance fraud, and other illicit activities may result from unauthorized access to healthcare data security.

Here are 7 ways that you need to follow to protect against vulnerabilities and improve your healthcare IT security:

1. Two-factor verification

Two-factor verification is a commonly used authentication technique in most healthcare organizations, and it remains a reliable username/password combination. Still, even with strong password policies in place, i.e., character limits, alphanumeric requirements,, and automatic expiration, they are not reasonably adequate to prevent a persistent attacker. This technique makes sure an additional security layer is in place, usually in the form of physical or biometric control, like swipe cards, security tokens, fingerprint scanners, or facial identification. While all offer a bonus degree of security and another obstacle for an attacker, the final two propose the strongest security while reducing the risk of forgetting or misplacing security devices.

2. Security checks and alerts

Nearly all healthcare IT systems in use today have some structure of practical observation that alerts IT staff to possible problems, such as performance degradation, storage space capacity, or unexpected outages. In the same way, security monitoring systems can recognize usage patterns and alert security personnel when exceptions arise. Rapid detection of potential security threats allows for a prompt resolution of issues before they compromise the system.

3. Encryption at Rest

IT departments prioritize the safe encryption of data during transfer, especially when it’s moving from a secure network to an external location like a teleradiology network. This safeguards data movement. While this protects data movement, it often leaves the data unencrypted when it is inactive in storage, leaving it vulnerable to an access breach. This extra layer of safety would prevent a probable intruder from decoding or dispensing the data in any meaningful way, even if they were to gain access.

4. Whitelisting

Application control, also known as whitelisting, involves limiting the applications, users, systems, and devices that can connect to your network to those openly listed on the ‘whitelist’. You cannot gain access if your name is not on the list. There are several ways to deal with whitelisting, including domain names, file and folder attributes, digital signatures, cryptographic attributes, physical or IP addresses, and more. Maintaining a whitelist, despite its seeming complexity, serves as an effective method to safeguard against vulnerabilities introduced by external users and non-IT department-controlled devices.

5. Retain a secure backup of your data

Ensure that a secure copy of your data is backed up and that you have a tested recovery plan in the event of an intrusion. This weakens these consequences and allows operations to continue as-is (or close) with little to no change in service delivery. Backups should be cross-geographical to prevent locking in potentially compromised systems and networks during attacks targeting data availability or consistency.

6. Blockchain

Although seldom put into practice in healthcare, this more developed alternative assures a highly secure (and valid) way to exchange data. The blockchain securely distributes data through a network of nodes that store, validate, and track information and transactions between them, ensuring that no single entity owns or has complete control over the system.

7. Look to the professionals

Another common problem in many healthcare organizations is the need for true security proficiency within the IT team. Because of budget restrictions, many IT personnel are known as ‘jacks of all trades’, mastering storage, server and workstation hardware, virtualization, software management, and more. To make sure your data and systems are well protected; it is necessary to employ a security expert. Engaging a professional resource, such as an experienced consultant, can assist you in identifying and implementing security controls and processes alongside your existing team.

At last, it’s essential to keep in mind that security is an ever-present necessity across the healthcare industry, and like many other aspects of healthcare IT, it does not offer a one-size-fits-all solution.

Why Velan HCS?

For over a decade, our legacy and established expertise as a medical billing service provider have exposed us to the complexities of the business. We keep track of every little change that is likely to impact your claims.

Read more on our site now, or give us a call at any time if you’d like to receive further attention. We would be delighted to answer all your queries.

Learn more about our services at Velan HCS.

Conclusion

Do you need a dependable medical billing service that values patient information and data security? Then bet your stakes on Velan HCS. Our professional group is familiar with the crucial importance of maintaining the highest standards, complying with legislation, and obtaining healthcare certification. Best practices and the highest level of security, allow you to focus solely on providing top-notch patient care. Protect patient health information and ensure the security of your healthcare data with the help of Velan for Medical Billing.

In today’s rapidly changing healthcare landscape, medical practices face numerous challenges when it comes to managing their revenue cycle effectively. The revenue cycle encompasses all administrative and clinical tasks involved in identifying, controlling, and collecting patient service income. With increasing regulatory requirements, complex billing processes, and evolving reimbursement models, many practices are considering outsourcing their revenue cycle management (RCM) to specialized service providers. This article aims to explore the benefits and considerations associated with outsourcing RCM and help you make an informed decision for your practice.

Understanding Revenue Cycle Management

Healthcare practices spend a significant amount of money administering the revenue cycle internally, but they also suffer losses as a result of a lack of automation, the use of non-integrated software, or manual operations. Learn why outsourcing revenue cycle management can help you get greater results at a portion of your current expense by reading this blog post.

For your doctors, running the business side of the practice can be laborious and unpleasant. Regarding revenue cycle management. Even though you have a workforce of competent medical professionals on occasion, your revenue cycle management may be inefficient, which could result in significant financial losses.

If your practice is dealing with a situation like this, you might be considering outsourcing. Consider outsourcing revenue cycle management because it has a significant impact on your bottom line. Your practice’s bottom line will increase if a group of committed professionals manages your revenue cycle.

To grasp the potential advantages and drawbacks of outsourcing RCM, it is crucial to first understand the key components of revenue cycle management. The revenue cycle typically includes patient registration, insurance eligibility verification, charge capture, coding and documentation, claims submission, denial management, payment posting, and accounts receivable follow-up. Each stage is critical to ensuring timely and accurate reimbursement for services rendered.

The Factors to Consider When Outsourcing Revenue Cycle Management

While there are many benefits to outsourcing RCM, there are certain crucial things to take into account before making a choice.

Goals and Values Alignment

When outsourcing RCM, it’s crucial to identify a service provider who shares the same aims and values as your practice. Look for a partner that recognizes your special requirements and is dedicated to establishing a long-lasting, cooperative connection. Consider how attentive, adaptable, and willing they are to tailor their services to your particular needs.

Reduce Costs and Increase Collection Rates

By outsourcing, your practice can reduce costs while improving collection rates. According to recent studies, it is much more expensive to manage an internal staff than to outsource medical coding and billing. Additionally, an outsourced team would include qualified coders and experienced billing specialists who may reduce your rejects while increasing your revenue. Using professionals can help you clear your backlog and even update your processes.

Pay Attention to Your Patients

The ultimate objective of every practice is to meet the needs of your patients and give them the best care possible. You can accomplish this while providing your patients with excellent service by revenue cycle management outsourcing. Your patients may be happier if billing errors and claim denials decrease. Meanwhile, with the burden of internal administrative labor lifted off your shoulders, you may devote more time to patient care.

Have a Higher Rate of Clean Claims

You must guarantee a higher percentage of clean claims—claims with no errors—if you want to increase the revenue for your practice. You can make sure that you submit error-free claims each time by outsourcing revenue cycle management to a group of knowledgeable and experienced experts. As a result, your practice will have a higher rate of clean claims.

Quality and Reputation

Thoroughly research potential RCM service providers to ensure they have a solid track record of delivering high-quality services. Factors such as their experience, client references, performance metrics, and certifications (e.g., Certified Professional Biller, Certified Professional Coder) should be considered. Request detailed information about their processes, training protocols, and data security measures to ensure compliance with privacy regulations.

Data Security and Compliance

Given the sensitivity of patient data and the increasing risk of data breaches, it is critical to assess any potential RCM service provider’s data security practices. Ensure they have appropriate safeguards in place to protect patient information and comply with HIPAA (Health Insurance Portability and Accountability Act) regulations.

Communication and Transparency

Effective communication is crucial when partnering with an external RCM provider. Make sure they provide regular updates, clear reporting, and accessible channels for inquiries and issue resolution. Transparent reporting and real-time access to financial and operational metrics will enable your practice to monitor performance and make informed decisions.

Alignment of Goals and Values

When outsourcing RCM, it is essential to find a service provider that aligns with your practice’s goals and values. Seek a partner who understands your unique needs and exhibits a commitment to building a long-term, collaborative relationship. Evaluate their responsiveness, flexibility, and willingness to customize their services to meet your specific requirements.

Utilize the Skills of Seasoned and Committed Professionals

If your internal personnel are multitasking and lack the necessary coding and billing expertise, you may be facing issues. Since billing and coding procedures frequently change, it’s critical to keep up with the most recent coding standards to minimize errors and denials. Outsourcing revenue cycle management allows you to keep track of HIPAA violations and reduce denials and errors.

Boost Precision and Effectiveness

Your billing procedures must be effective and precise if you want to keep your practice in business. Improper coding procedures, unpaid claims, or ignored claims can negatively impact your cash flow. On the other hand, outsourcing can improve your cash flow while also ensuring that your procedures are correct and effective.

Gain Insight into Analytics

Your practice can have daily access to dashboards and performance metrics when you outsource. With analytics, you can track billing activity and performance without micromanagement.

Conclusion

Outsourcing revenue cycle management can be a strategic decision that offers numerous benefits to medical practices. It provides access to specialized expertise, cost savings, advanced technology, scalability, and the ability to focus on core competencies. However, it is critical to carefully evaluate potential RCM service providers, taking into account factors such as quality, data security, communication, and goal alignment. Alternatives, such as in-house RCM and software solutions, should also be considered, depending on the unique needs and resources of your practice. By conducting thorough research and weighing the pros and cons, you can make an informed decision that maximizes revenue, improves efficiency, and enhances the overall financial health of your practice.

Have you ever experienced the overwhelming feeling of being inundated by a large number of invoices and receipts?

Are your claims and follow-ups negatively impacting your productivity?

“Are you experiencing the phenomenon of working longer hours than usual, at the expense of your personal and social life?”

“Does it seem like your recent activities have primarily involved pursuing payers in order to maintain the smooth operation of your revenue cycle?”

“Do you sometimes feel more like a professional medical biller than a physician, given that your attention is primarily directed towards claims and billing?” 

You are not alone!

Outsourced medical billing services can be highly demanding for small medical practices. The medical industry constantly goes through tremendous change. Dynamic regulations and stricter norms that govern the industry continuously shape its evolution.

If there’s one thing that medical billing heavily relies on, it’s accuracy and precision. A misplaced decimal or a missing zero could result in a ruthless rejection. Hence, it is highly critical to pay close attention to it. If you take it upon yourself to scrape through the various stages of billing and claims, you’re likely to miss out on your optimal patient care services.

This leaves you with two likely choices: one, to outsource medical billing services to a professional medical billing company, and two, to onboard an in-house medical billing team.

If you own a medical practice and have read this far, you’re probably wondering if outsourcing could work for you. We’re here to help you with some pointers in that direction. We’ve put together a list of five reasons why we think outsourcing your medical billing services may be right for you.

Speed and Economy

Your outsourced medical billing services will cost you a lot less than hiring and training a medical biller for your practice. Look at it this way: when you onboard an employee, you’ll also have to account for his or her overhead, insurance, paid vacations, and training costs. In addition to these expenditures, you must consider infrastructure costs such as installation and maintenance.

There will also be instances where you lose revenue due to billing errors and inadequate billing practices. You can eliminate all these bothersome expenses with reliable outsourcing. Working with a professional medical billing company will make a world of difference when it comes to billing errors. This will subsequently help your practice receive swifter payments and reimbursements.

Professional medical billers, like Velan HCS, work closely with insurance companies to better understand their processes, resulting in a shorter revenue cycle for clients.

More stress-less time

Managing and owning a medical practice is a challenging task. And as a physician, you’re likely to have a full plate. To be laser-focused on what you do best, i.e., treating patients, you should relieve yourself of the headaches involved in billing. We know you don’t have time to worry about tracking your medical billing or following up on a clearance claim. Working with a medical billing company allows you to free up your time and finally feel like a physician again.

The dynamic and ever-changing regulations constantly create headaches, even for in-house medical billers. With the ever-impending threat of an inspection, many medical practices are turning to professional medical billers.

If you don’t want to worry about compliance or chasing denials, let the billing company handle it. So you can finish that crossword puzzle before work, let them try.

Money

Outsourcing can save your practice thousands of dollars in annual salaries, perks, medical insurance, office supplies, furniture, software, equipment, and other costs. The software and billing equipment would require periodic upgrades and maintenance.

Most medical billing service providers charge a flat rate per claim. Some billing companies charge a percentage of the reimbursement on each claim, which might at times exempt charges on a failed claim. Either way, all this will account for a lot less than what you would pay for an in-house medical billing team.

So, why not save your practice some money, keep the revenue cycle ticking, and provide exceptional services with a primary focus on patients by simply outsourcing your billing?

Customer Satisfaction

Now that you’ve got the billing fiasco out of the way, you can spend more time doing what you do best: patient care. You’ll now have enough time to provide quality care to your patients. This will be highly desirable, especially for smaller physician groups that cannot afford large medical office staff. If you are bogged down by the financials of running a practice, it is likely to hurt the patient care that you provide.

A 4.8-star rating for your medical practice on Google is likely to generate more business for your practice than a 3.2-star rating. These are purely based on the customer service you offer. So, the ability to provide patients with excellent customer service can both retain old patients and generate new ones. However, juggling between the demands of rendering optimum customer service and handling billing issues effectively is almost impossible. 

Improved billing compliance and increased cash flow

One of the many hurdles in medical billing is coping with the changes according to regulations and authorities. Insurance companies are partially culpable. One aspect of third-party payers is their special task force that looks into whether a medical office that has agreements with such a party payer does everything possible to follow the protocol each payer demands. It is therefore very important for medical billing service administrators to keep an eye on recent changes in norms and regulations so that they can maintain compliance and submit clean claims.

COVID-19’s effects on medical billing and the healthcare sector are significant.

Medical billing, the critical link between medical coders, insurance companies, healthcare providers, and patients, is a key part of the overall revenue cycle for hospitals. A medical biller is there to ensure that the healthcare provider receives proper reimbursement for insurance claims, so he will always put his patients’ health first (that’s straightforward if we consider that he also works in a dental office). asserts.

Medical billing efficiency gets even more critical. One of the impacts as a result of COVID-19 is that we are losing the ability to bill out for certain lost revenue. Now more than ever before, this shines light on our need for medical billing efficiency. For the U.S. hospital, a moderate influx of COVID-19 patients is linked with an average decrease in gross revenue of 50%, according to surveys. An effective medical billing system, which could be in-house or outsourced, guarantees a steady revenue cycle and also ensures there won’t be any further exacerbations.

COVID-19 is taking its toll on the healthcare industry.

Combining the loss of jobs driven by COVID-19 and a massive reduction in revenue from Medicare funding, it is expected that there will be a logical move away from the post-commercial insurance era towards some form of socialized or government-backed model.

Meanwhile, government programs pay for nearly 50 cents (45.7 percent) of every dollar spent on healthcare—even more considering that some nonprofit services and institutions used by publicly insured patients are excluded from the totals. People’s payroll contributions largely fund these services through Medicare. Reports indicated that this would further strain Medicare, with 30 million Americans unemployed and another 27 million at risk of losing their employer-based insurance coverage, reducing payroll contributions to company fund authority for the program and leaving it insolvent.

This is going to hit all of those healthcare billing service providers who have been using their margins from commercial insurance to subsidize the losses they take on poorly reimbursed government programs. Without this scuttling of costs, healthcare providers could see a sharp loss in revenues as more government-funded programs are held as alternatives.

As people refrain from going to hospitals, telemedicine companies are also growing. Telemedicine and digital health can be key tools to achieve the goal of high-quality care at a lower cost. VC funding in this segment grew to $7.4 billion in 2019, and there is even more room for tech-enabled remote monitoring and diagnosis going forward.

The Future of Medical Billing and Coding Services in the Healthcare Industry

The capacity of the worldwide healthcare system to tackle COVID-19 has been demolished. There is a tremendous dearth of medical staff, places, and emergency centers for the healthcare industry as it becomes overburdened. During COVID-19, the healthcare industry must direct medical accounting and healthcare professionals where needed most while ensuring safety for staff to keep patient care operations running.

At the same time, patients are also responsible for their financial burden, as some have left medical bill obligations unmet in the wake of coronavirus symptoms.

Ever since the inception of AI tools, there has been a significant drop in all sectors using traditional methods. The same goes for the health sector. Automation and AI are doing heavy lifting on medical coding tasks that used to be very difficult because they were time-consuming.

As the patient base evolves and regulations change, providers need help keeping up with a constantly growing healthcare environment. Businesses in the healthcare field have turned to technology as one of their means to survive and thrive in a competitive market. This technology automates billing, payments, and all other administrative work.

One of the ways to guarantee quick reimbursement is through medical billing automation. In addition, when using automated medical billing software, providers can also generate superbills and submit claims right after the patient has been treated.

This seriously decreases the number of unpaid claims, and it helps get money back in your pocket much faster.

Conclusion: RCM’s Future in AI

It allows for the automatic completion of manual invoicing tasks, making the billing process more efficient. This means AI can automatically spot errors in claim submissions, allowing payers to correct them before processing. This frees up doctors and other professionals to focus on more important matters than fixing patients’s mistakes.

Given the constant flux of regulations and business trends, staying current on the latest technology is important, as that area changes constantly with new ways to reduce costs, increase efficiencies, or make money.

This can be done by integrating AI with the revenue cycle management processes. Faster revenue cycle management processes: Data-driven administrative duties are automated, lowering the amount of administrative waste.

Benefits of medical billing & coding services

Invoicing software is used to automate most of the process so that you can say goodbye to stacks and files of paperwork. This manually accomplished job makes businesses susceptible to mistakes, but invoicing cookies might cut documents in half.

By enabling medical billing outsourcing services automation, paperwork and associated errors in physical form submissions can be reduced.

Automated invoicing systems help cut down on the number of errors made in managing claims and billing, as they provide easy options for processing them without breaking a sweat.

Eliminate paperwork in healthcare using automatic invoicing, which helps you save hours on form-filling.

By automating all our billing, we were able to save a lot of time and effort.

Given miscommunication and the different billing practices from one payer to another, this calls for a more accurate system of medical billings. In general, these billing errors could develop and rapidly circulate over the years.

By automating your billing process, you will free up more time to spend with patients face-to-face. Long-term patient health is beneficial for your clinic. Better doctor-patient relationships only mean superior outcomes for patients and, thus, better financial gains in the long run, i.e., the continued existence of your practice!

Automated billing: increasing accessibility for patients

The procedure and availability of patient billing data are improved by means of this automated medical billing software. Patient data is accessible via remote.

In turn, this allows you to centrally update accounting information and chase overdue payments that your staff can access when in the office or out on the job.

Speedy, more efficient payments require access to trusted and well-rounded information.

Medical Invoicing + A.I.

One of the most powerful healthcare AI applications is to automate invoicing and coding. Automation can help clerks do their billing tasks much faster and more accurately than they normally would.

AI can also identify and correct billing errors. That could decrease hospitals’ and clinics’ overall loss from billing errors.

Artificial intelligence collects and processes data on patient care to assist healthcare professionals in measuring trends and patterns. Using this data, the treatment and care strategies of the patient can then be optimized.

Benefits of AI in Medical Invoicing

Medical billing and coding services across all healthcare sectors. You can better understand the implications by considering the following advantages:

We can automate the coding process to create a low-skilled invoicing specialist solution that scales.

By issuing properly timed and accurate patient statements, you can improve cash flow.

A reduction in the normal work week for administrative staff could lead to productivity gains.

Real-time auditing bypasses the problem of not being able to identify an error in time to rectify it without spending a lot.

AI reduces the number of people and hours required to train manually to perform these tasks.

In addition, with AI, you can reduce the number of customer service inquiries or disputes regarding patient statements and save on other operating costs.

Top Barriers in Healthcare for AI

Complex code systems use sensitive ICD-10 and CPT codes that are hard to automate in medical invoicing.

Accuracy of the model in outsourced medical billing services, AI precision, and recalls are two popular indicators used to evaluate an evidence model; they, however, show more data integrity issues because medical billing continues inconsistently with false or incomplete claims due to deliberate overbilling practices for profit’s sake.

Integration with legacy systems

Many healthcare organizations still rely on older technology tools and may need to connect their existing technologies to the latest AI or automation innovations.

Difficulty in transforming

Obstacles in adoption: The integration of AI and automation solutions in healthcare may encounter difficulties due to the hesitancy of healthcare providers and billing businesses to transition from conventional techniques.

Cost and resource implications

AI and automation solutions often require heavy investments in hardware as well as skilled personnel to operate efficiently. This will be an impossible goal for some organizations.

Vagueness

The invoicing decisions made by AI can be opaque, which perpetuates errors and doubt.

Cyberthreats

The more that medical billing outsourcing services are automated, the greater the likelihood of data being exposed by hackers.

Best practices for billing and data protection

HC C&BT will implement important steps to secure sensitive data.

Protocols for encryption

We use advanced encryption algorithms to protect sensitive patient and financial information. In healthcare billing services, these protocols ensure the security of any PHI data exchanged between vital healthcare components, including providers, insurers, and invoicing entities. This also helps healthcare organizations comply with regulatory standards like HIPAA, which increases trust among patients and stakeholders and ensures better integrity through greater reliance on the medical invoicing process.

Access controls include

Access controls are used to enforce permissions, which ensure that only people with the need and right can access certain system information. This is particularly useful, as it helps to limit the amount of restricted data and who can view or modify invoice data in any coming transactions. Improves security for known issues and meets healthcare laws (e.g., HIPAA). Access controls are critical to protecting patient trust and creating confidence for the administration of sensitive healthcare information in an appropriate manner based on the confidentiality, integrity and availability of RCM or relevant data.

Authentication mechanisms

The authentication methods in such systems usually use two-factor security, which generally involves users requesting more than one type of verification, either a combination of passwords, smart cards, or biometrics. Robust authentication protocols used by healthcare organizations help reduce the probability of data breaches and unauthorized access.

Perform routine audits and monitoring

Ensuring the invoicing system is running with integrity—thanks to continuous auditing and real-time monitoring of its activities—helps detect any irregular behavior. Furthermore, practices can assure compliance with industry regulations like HIPAA and detect any discrepancies in billing records sooner.

Firewalls and intrusion prevention systems

However, firewalls and intrusion prevention systems should be put in place to control the flow of network traffic and protect your brand from cyber threats, as well as prevent any unauthorized access. With the convergence of these technologies, a robust stance can be taken to ensure that patient and financial data are secure from intrusions. Firewalls and IPS: These also increase the overall resilience of invoicing infrastructure by securing against unauthorized access and other unwanted traffic.

Employee training and awareness

Have an informed and educated staff. Having an educated and trained staff is paramount to preventing security breaches and maintaining compliance with regulations such as HIPAA. Dangerous, clumsy leaks of information are prevented through continuous training regarding the best practices for protecting data and developing a real awareness culture. Training programs that inform employees of the most current safety concerns, along with data protection protocols and proper management of sensitive information.

Drawing from the above points, technology-driven billing systems can help protect the confidentiality of sensitive financial and personal information through their approach to secure patient data, and so on.

Why Velan HCS?

Background details and experience in outsource medical billing services over more than a decade have given us exposure to the intricacies that come along with it. We keep on top of every new rule that could help with your cases.

We look forward to providing our services and becoming a part of the Velan family, consistently meeting your billing requirements.

If you would like to know more about what we do and how to be better at it, go check out our site for outsourced medical billing services, or fill out the form below and request a free quote.

Call us today.

Embrace a stronger canvas for a smooth journey through the maze of receipts!

Our expertise in medical billing at Velan HCS can help you decrease denials and expedite the clearing of your claims.

Over 95% of the time, we at Velan HCS send in clean claims.

To survive the challenging times in the US healthcare industry, a number of companies have come up with some fairly creative and unusual ways to reduce expenses, boost revenue, shorten turnaround times, and streamline operations. Most enterprises usually give top priority to a contract with a reputable medical billing outsourcing company, which is virtually ubiquitous in India.

At first, it was thought to be a cost-cutting measure to contract with a medical billing company to handle part of the revenue cycle management. Cost-cutting by itself, though, will not meet the demands of American healthcare providers. They need practically immediate help from a service provider who functions as an extension of their company and can handle unforeseen workload increases, which are a natural part of the business.

For businesses that contract with outsourced medical accounting services for billing, judicious turnaround—which is usually a major operational barrier in the market—is no longer an issue. Actually, it is widely known that Indian medical billing service providers are well-oiled machines that can quickly manage unforeseen surges in job volume, even if they approach 40%, without delaying turnaround times. Any client will definitely be pleased with this kind of business continuity.

The Emergence of Healthcare Outsourcing

Although outsourcing is not a novel idea in the healthcare sector, in recent years, these partnerships have expanded dramatically in both scale and importance. Outsourcing certain aspects of operations to specialized service providers in nations like India is increasingly bridging the gap between the United States healthcare system and the global workforce.

Why do US healthcare providers choose Indian outsourcing firms?

Many times, medical billing outsourcing companies kept medical professionals in the dark. The times have surely changed. These days, outsourcing companies have grown. They provide clients with regular analytical reports and discuss operational specifics with them in order to help them make wise decisions about their long-term growth.

Cost savings: The group has grown mostly because US healthcare providers are able to achieve substantial cost savings. Outsourcing to Indian companies is a desirable choice because India has substantially lower labor and operating costs than the United States.

Expertise and Quality: Processes and technology in this field are often well-known to Indian outsourcing companies. They engage very talented professionals who are proficient in doing challenging tasks, including radiography reporting, billing, typing, and medical coding. This experience contributes to raising the standard of service.

Compliance and Data Security: Indian outsourcing companies comply with stringent US data security and privacy laws, particularly HIPAA. They make investments in robust security measures and policies to safeguard the integrity and secrecy of patient information.

Scalability: Healthcare providers have the flexibility and responsiveness to change demand and adjust their outsourcing needs up or down as necessary. This scalability is particularly helpful in the frequently changing healthcare industry.

Increased patient satisfaction is the outcome of US healthcare providers reallocating their resources and attention to important activities like patient care, research, and innovation by outsourcing non-core tasks.

The Effect on Industry

Cost reduction: By allowing healthcare providers to significantly reduce operational costs, patients may eventually pay less for their services.

Enhanced Efficiency: Healthcare professionals can reduce errors, streamline processes, and increase overall efficiency.

Increased Patient Care: Better results and patient satisfaction come from healthcare staff having more time to provide patient care when the administrative burden is lessened.

Technology Developments: Indian outsourcing companies regularly make investments in state-of-the-art software and technology, giving US healthcare providers access to the newest developments in healthcare administration and IT.

Global Partnership: By encouraging the sharing of best practices and healthcare innovation, international partnerships between healthcare professionals in the US and India develop a worldwide perspective.

Obstacles and Points to Remember

There are certain challenges, even if the cooperation between US healthcare providers and Indian outsourcing companies has many advantages. These could be time zone differences, communication barriers, or regulatory compliance. To allay these fears, healthcare providers need to carefully choose their outsourcing partners and put in place strong communication and security procedures.

Different research on the US outsourcing market revealed that Indian outsourcing companies helped businesses that decided to outsource save over $6 billion.

Indian medical billing companies are partnering with US companies to support the US healthcare industry as it progresses into the next stage of ongoing growth.

Own an American healthcare business?

Handling healthcare revenue cycle management services in-house is a challenge. Velanhcs skilled RCM team can manage it, offering you a sense of comfort and future focus on customer service. Contact us now!

Any gastroenterologist knows that GI services are hard to bill. To receive payment for the delivery of your services, you have to comply with a large number of codes and regulations. This blog post reviews key principles for billing GI services. We discuss everything from CPT codes to ICD-10 codes. We will also provide tips on how to earn higher pay for your services. Therefore, if you are ever interested in a how-to-bill GI series with much-needed guidance about billing for your gastroenterology services,.

Gastroenterology Definition

What is Gastroenterology medical billing? It is a segment of medicine that deals with the diagnosis and treatment of diseases impacting the stomach, esophagus, large intestine, small intestine, gallbladder, biliary tree, and pancreas. Gastroenterology has a wide range of diseases, from common ones like diarrhea and heartburn to serious ones (e.g., colitis and cancer). They also provide colon cancer prevention and screening. Gastroenterologists are trained in endoscopy, a procedure that requires the use of tubes or scopes to see inside body cavities. Gastroenterologists use endoscopy to treat and diagnose conditions like ulcers, tumors, or blockages. Naturally, as medical practices evolve with time, gastroenterology is one of the specialties that tend to experience sudden growth and changing procedures.

Gastroenterology Medical Billing Services

Medical billing is the process of submitting and following up on claims to health insurance companies in order to receive payment for services rendered by a healthcare provider.

Coding: Conversion from billing to numerical codes related to medical diagnoses and treatments. The importance of medical billing and coding in gastroenterology is that they help clinicians get reimbursed for the services offered to a patient.

Endoscopies, colonoscopies, and upper GI endoscopies are some of the procedures performed by gastroenterologists. All of these standardized procedures can be utilized with a specific code that represents the medical procedure used to prescribe drugs or medications under insurance, so long as the mentioned process is completed successfully. To process claims properly, medical billers and coders need to be knowledgeable about diagnosis codes in addition to procedure codes. Many diagnostic codes can be used by gastroenterologists (e.g., GERD, abdominal pain, and celiac disease). When it comes to medical billing and coding in gastroenterology, the range of services can tend to make things challenging. Nevertheless, gastroenterologists can make sure that their claims are submitted accurately and promptly by working with trained medical billers and coders.

Outsourced Gastroenterology Billing Workflow

When a patient receives medical care from a provider, such as in the office of a doctor or outpatient clinic (or hospital), the process starts. The provider will then create a claim; essentially, this is the same as an invoice in any business except that it lays out what services were provided and how much each one of them costs. This sends the medical claim to their insurance for payment. The insurance carrier also has to process your medical claim and determine if it adheres to its provisions for you to receive payment. For each medical claim that is approved, the insurance company will pay for a portion of or the full cost of whatever service is provided by the provider. Medical billing is a complicated process, and providers have to understand it so that they will receive payment for their services. Medicine is complicated, and gastroenterologists should work with experienced medical billers to ensure their claims are correct.

Top Professional Outsource Healthcare Billing and Coding Services

Outsourcing medical billing can be an effective way for healthcare providers to manage their revenue cycle efficiently. One of the primary benefits of outsourcing is the ability to leverage the expertise of specialized billing companies that are well-versed in the nuances of medical billing and coding. This is particularly beneficial for gastroenterologists, who often deal with complex procedures and a wide range of diagnostic and procedural codes.

Velan HCS is one such company that provides comprehensive medical billing, credentialing, and accounts receivable management services. They specialize in ensuring that claims are accurate and compliant with the latest healthcare regulations, which can significantly reduce the likelihood of denials and improve overall revenue.

Outsourcing can also save time and reduce costs. Medical practices do not need to invest in hiring and training staff or maintaining the latest billing software. Instead, they can focus on providing quality patient care while the billing company handles the administrative burden. However, it is important to choose a reliable and experienced billing partner to avoid potential issues related to control and data security.

Coding and Billing in Health Care: Best Practices for Gastroenterology

Medical billing for gastroenterology is the process of submitting and following up on claims with health insurance companies to receive payment for services such as office visits, colonoscopy, endoscopic retrograde cholangiography (ERCP), and endoscopic ultrasound (EUS). A medical coder takes the text in a patient chart and applies codes to diagnoses and services per an established classification system so claims are accurately processed by payors (and you get paid). Gastroenterologists are required to familiarize themselves with the coding system used to correctly code for the medical services rendered. Another step for pathologists (and other providers) is to be knowledgeable about the criteria established by various insurance companies and third-party payers to avoid denial of reimbursement. Following coding guidelines will help ensure your medical billing is correct and payouts come through on time for gastroenterology.

Billing and Coding for Upper Gastrointestinal Endoscopy

The following ICD-10-CM codes support medical necessity and offer coverage for CPT codes: 43200, 43201, 43202, 43204, 43205, 43206, 43212, 43215, 43216, 43217, 43220, 43226, 43227, 43229, 43231, 43232, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43252, 43255, 43257, 43259, 43260, 43261, 43262, 43263, 43264, 43265, 43266, 43270, 43274, 43275, 43276, 43277, and 43278.

In certain cases, a physician may need to state that a procedure or service was unique or independent of other services, and CPT® modifier 59 may be appropriate depending on the circumstances. CPT® Modifier 59 is used to identify procedures or services that are not generally reported simultaneously. This includes the following procedures or services that are not commonly encountered or performed on the same day by the same doctor:

A different session or patient interaction

A different procedure or surgery

A different site or organ system

A separate incision/excision

A separate lesion

A separate injury (or area of injury in serious injuries)

When an existing established modifier is acceptable, it should be used instead of CPT® modifier 59. CPT® Modifier 59 is an important National Correct Coding Initiative (NCCI)-linked modification that is frequently misused. It should only be used when no other descriptive modifier is available or when it best describes the situation.

For example, the 59 modifiers can be used with the codes shown below:

45380 — Flexible colonoscopy with biopsy, single or multiple

45385 — Flexible colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) using the snare technique

45386 — Flexible colonoscopy with trans-endoscopic balloon dilation

45387 — Flexible colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps or bipolar cautery

Proper coding and modifier use are crucial for accurate billing and avoiding claim denials. Gastroenterologists must stay updated on coding guidelines and payer policies to ensure compliance and maximize reimbursement.

ICD-10 and CPT Codes in Gastroenterology

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the Current Procedural Terminology (CPT) codes are essential tools for gastroenterology billing and coding. These codes standardize the reporting of diseases and procedures, facilitating accurate billing and insurance claims processing.

ICD-10-CM codes are used to describe the patient’s diagnosis, while CPT codes are used to describe the medical procedures and services provided. For example, a colonoscopy might be coded with CPT 45378, and a diagnosis of irritable bowel syndrome might be coded with ICD-10-CM K58.0.

To ensure proper reimbursement, gastroenterologists must use the most specific and accurate codes available. This often involves keeping up with annual updates to the coding systems and payer guidelines.

Challenges in Gastroenterology Billing

Billing for gastroenterology services comes with a unique set of challenges. These include dealing with a wide variety of procedures, each with its specific codes and guidelines, as well as managing the documentation and coding for complex cases that may involve multiple procedures or comorbid conditions.

Another significant challenge is staying compliant with constantly changing regulations and payer policies. Failing to adhere to these can result in claim denials, payment delays, or even audits and penalties.

To navigate these challenges, many gastroenterologists turn to specialized medical billing services. These services can provide the expertise and resources needed to manage billing effectively, ensuring accurate claims submission and timely reimbursement.

Top Professional Outsource Healthcare Billing and Coding Services

Outsourcing medical billing can be an effective way for healthcare providers to manage their revenue cycle efficiently. One of the primary benefits of outsourcing is the ability to leverage the expertise of specialized billing companies that are well-versed in the nuances of medical billing and coding. This is particularly beneficial for gastroenterologists, who often deal with complex procedures and a wide range of diagnostic and procedural codes.

Velan HCS is one such company that provides comprehensive medical billing, credentialing, and accounts receivable management services. They specialize in ensuring that claims are accurate and compliant with the latest healthcare regulations, which can significantly reduce the likelihood of denials and improve overall revenue.

Outsourcing can also save time and reduce costs. Medical practices do not need to invest in hiring and training staff or maintaining the latest billing software. Instead, they can focus on providing quality patient care while the billing company handles the administrative burden. However, it is important to choose a reliable and experienced billing partner to avoid potential issues related to control and data security.

Another reputable outsourcing option is Billings Clinic Gastroenterology, which offers end-to-end revenue cycle management services. MBC’s team of certified coders and billing specialists ensures that claims are processed accurately and efficiently, helping healthcare providers maximize their revenue.

Additionally, Accurate Billing provides tailored billing solutions for gastroenterology practices. Their services include claim submission, denial management, and patient billing, all designed to streamline the revenue cycle and reduce administrative burdens on healthcare providers.

When choosing a medical billing service, it’s essential to consider factors such as the company’s experience in gastroenterology billing services, its compliance with industry standards, and its track record of success. By partnering with a top professional outsourcing service, gastroenterologists can ensure that their billing processes are efficient, accurate, and compliant, ultimately leading to better financial outcomes and more time to focus on patient care.

Conclusion

Effective billing in gastroenterology requires a thorough understanding of coding systems, payer policies, and the specific challenges associated with GI procedures. By staying informed and leveraging the expertise of professional billing services, gastroenterologists can optimize their revenue cycle, reduce claim denials, and ensure timely reimbursement for their services.

Whether you choose to manage billing in-house or outsource to a specialized company, the key is to maintain accuracy, compliance, and efficiency in your billing processes. This will not only improve your practice’s financial health but also allow you to focus more on delivering high-quality care to your patients.

Ambulatory Surgical Center (ASC) billing outsourcing services simplify and streamline the process, leading to a greater return on investment (ROI). Offshore Outsourcing can help US-based Medical Billing Companies gain better benefits and profitability. Ambulatory Surgical Centers have more criteria and specialty-based subtleties when it comes to charting out claims and processing them with insurance payors, making it difficult and time-consuming to manage in-house. To understand why outsourcing has become the latest trend in ASC, let us try to comprehend the intricacies involved in billing for ASC.

What is an Ambulatory Surgical Center?

Ambulatory Surgical Centers are organizations that offer outpatient surgical services as part of a large medical group, a hospital, or as a standalone facility. CMS has stipulated that only specific surgical procedures can be performed in an ASC setting. These characteristics and standards from CMS and Medicare protocols distinguish ASC from other specialties. As a result, the medical billing process for ASC can be relatively complex and intricate.

ASC Medical Billing and Coding Challenges

As they are mostly a combination of hospital and physician medical billing claimed on the professional claim form CMS 1500, medical billing and coding for ASC can be very different from other medical specialties or the typical physician billing or facility billing.

ASC billing utilizes Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) codes.

Because ASCs cover the majority of hospital-based treatments but are billed on the physician billing claim form, billing and coding for ASC services can be very varied and variable, even if the same principles and protocols are followed.

CMS and Medicare only allow certain surgical procedures to be performed in ASCs, making insurance billing and reimbursement difficult due to OON coverage restrictions.

It is required for ASC to deliver services that have been diagnosed by primary care physicians.

Frequent updates to coding guidelines and billing requirements can further complicate billing and coding for ASC, necessitating an experienced billing and coding team with an understanding of ASC claims processing.

With the rising attrition rate and staffing challenges caused by the current pandemic, it can be difficult to find and keep highly skilled ASC billers and coders. Inadequate or inexperienced workers might have an impact on revenue cycle management and monthly collections. Offshore outsourcing can provide you with a professional staff to rely on during times of hardship or uncertainty. Outsourcing ASC billing can be useful in several ways, as outlined below:

Skilled claim management, with an awareness of the subtleties of specialization and customer.

Insightful approach with insurance carriers, understanding how to deal with claim rejections, denials, and low payments, ensuring that the claim is closed with the maximum compensation.

Unlike in-house billing, which can be hampered by employee absenteeism and attrition, we provide continuous service coverage.

It eliminates the overhead costs associated with hiring, recruitment, training, staffing, infrastructure, upgrading to advanced technological tools, and adjusting your workforce to them.

Dedicated team and account managers to guarantee that the entire revenue cycle management process runs smoothly and stress-free, with a focus on your bottom line.

Current Trends in Ambulatory Practices

ASC hospital and ambulatory surgery center billings have been turbulent for almost all industries in 2021, including the medical field. Across healthcare, many specialty-based practices and medical groups saw drastic declines in patient volumes they never anticipated or could afford.

Ambulatory Surgical Centers (ASC) suffered significantly during COVID-19 and the pandemic. However, recent trends show that ASCs are the fastest-expanding section in the medical field. Ambulatory surgical center trends are discussed in this article.

Upgraded Technology and Techniques:

New technology for non-invasive procedures has recently emerged, as have advanced operating room configurations. What is clear, though, is that you want to keep your ASCs at the top of their games by updating them with newer technologies to maximize financial benefit and achieve continuous business success.

Telehealth & Virtual Care:

Thanks to state-of-the-art technology updates, professionals can now pay attention to how they want to provide patient care. Mobile Apps, Telehealth Settings Drive Boost in Patient Visits Ambulatory Practice: Virtual or remote patient care has been a boon for the practice to be successful.

Prioritize patient care:

For that matter, ASC has to eliminate all distractions to deliver only shared attention, resulting in quality treatment and patient delight. As opposed to being an in-patient or hospital stay, at ASCs, patients have their surgical procedures within the specified time frame, which is typically 24 hours. During these brief hours of service, both physicians and patients anticipate a stress-free environment to facilitate treatments. With a team of billing and coding experts handling the billing functions, ASCs should be able to establish themselves as the top service provider in their area.

ASC Billing and Coding:

Coding criteria for ASC are continuously revised, and coders and billing teams should adhere to the CMS guidelines to avoid errors that lead to denials. With skilled coders and billers assigned to manage ASC billing, any practice should be able to withstand the pandemic and beyond.

Running an ASC practice is no simple task, and when it comes to billing, it is better left in the hands of a billing partner who specializes in providing medical billing services exclusively for an ASC. Thus, this indirectly ensures your safe and secure billing, which leads to commendable cash flow and affects patient care.

Offshore Outsourcing

The benefits of offshore outsourcing revenue cycle management are certainly greater.

Time and cost savings:

For billing partnerships, offshore outsourcing has been turning out to be the most suitable option for everyone because it saves time and costs too. As we see, amidst a global pandemic, offshore has grown to an even larger scale of outsourcing than what most practices and billing companies have currently been using in their business models.

Ambulatory surgical center billing services have the following advantages:

A well-established medical billing company has hands-on experience handling the multi-specialty billing procedure.

Experienced and skilled crew with frequent training for upgrades and modifications.

Coders and billers have experience managing claims for multiple payers, making it easier to adjust to billing requirements that are specific to the client or payor.

Increased quality and denials are under control.

Efficient accounts Receivables and Denial Management.

End-to-end Revenue Cycle Management.

Common Billing Mistakes That Drive Down the ASC Revenue Cycle

Let us examine in depth the billing errors that push down the ASC Revenue Cycle.

Insurance eligibility and benefit verification are missing from ASC billing

Verifying insurance eligibility and benefits before service coverage is critical for determining payment responsibilities and avoiding unneeded confusion and follow-ups after services. This will also help to reduce major reimbursement delays caused by incomplete or incorrect claim information.

Failure to get prior authorization and a referral:

To improve the quality of the billing process, the streamlined process should include ensuring that proper authorization and referral numbers are received as needed by the policy.

Delayed Claim Submission:

The difficulties associated with billing for ASC may result in delayed claim submission; yet, it is critical to ensure that the files are completed and sent within the Turnaround Time (TAT). This can be accomplished by implementing a streamlined billing procedure and assigning a skilled and experienced team to manage ASC claims.

The Billing Process Is Not Streamlined:

Ambulatory surgical center billing services can be more difficult and complex than billing for other specialties; nevertheless, a streamlined billing approach with suitable rules and process protocols can help avoid billing errors and ensure smoother and faster invoicing.

Neglecting Critical Information:

Understanding payer contract subtleties, coding specific criteria, and adhering to CMS contract laws and regulations will all benefit your bottom line. Furthermore, ASC billers should be updated with managed care contract payment techniques and carrier-based policies to ensure your process is intact at every phase of revenue cycle management.

Medicare Payment Guidelines for ASC Billing Ignorance:

Medicare has established payment standards for ASC billing services, which state that ASC services are covered by Medicare Part B and that claims must be submitted solely in Claim Form CMS 1500. Some commercial payors accept ASC claims in CMS 1500, and other insurance companies accept the UB04 claim form. Here are the Medicare ASC billing and claim filing guidelines:

ASC cannot include different line items or HCPCS Level II codes on separate bills for procedures, services, medications, equipment, DME, and so on.

ASC will be compensated for these, but they will be included as a package in the authorized payment. For example, the budget for surgical treatments will include all services, medications, gadgets, post-operative pain management, and other expenses.

Outsourcing ASC Medical Billing

With all of the complications outlined above, Ambulatory Surgical Center (ASC) billing and coding require a competent and streamlined strategy to ensure maximum efficiency. Outsourcing ASC medical billing to an offshore medical billing company with high customer retention and experience managing various specialties might benefit your entire financial health.

6 Important Things to Know About Ambulatory Surgery Centers Billing and Coding Services

Many providers and healthcare organizations work with professional medical billing companies in the hopes of receiving ASC billing services as well. However, most US medical billing organizations lack the expertise to handle ambulatory surgery center billing. ASC medical billing and coding differ from processing traditional physician billing claims. It has numerous variations and is highly sophisticated in terms of billing and coding. Because there is potential for significant claim denials, the in-house medical billing team cannot handle both conventional and ASC billing independently. As a result, engaging with an offshore vendor who is proficient in ambulatory surgery center billing would be the best option. In this post, we’ll look at the six most important aspects of ASC billing and coding services, as well as how offshore suppliers can help with them.

Facts About ASC Billing: In what ways do ASC medical billing and coding differ from traditional physician billing?

To know the solution, we must first understand how ambulatory surgery facilities operate.

According to Medicare, ASC is an independent company that offers outpatient ambulatory surgical services exclusively to its consumers.

Sometimes, it might be managed as a part of a large healthcare facility and labeled a “provider-based department of the hospital.”

ASC does not offer office visits, laboratory services, or diagnostic tests.

New trends:

To be eligible for compensation, Medicare expects ambulatory surgical center billing guidelines to sign up for a participating provider agreement with CMS.

CMS intends to convert ASCs into “bed-less hospitals” to lower patient bills. This allows patients to have their operations and be discharged on the same day. They can heal from the comfort of their own homes by contacting their providers via phone.

Ambulatory Surgical Center Billing Services: How Does It Work?

Unlike traditional physician billing, ambulatory surgery facilities use a blend of hospital and physician billing.

Most ASC billing systems utilize CPT and HCPCS Level II codes. Some insurance companies allow ASC services to be billed using ICD-9-CM numbers.

ASC claims should be filed using the CMS 1500 form according to Medicare requirements.

Medicare also requires CG modifiers to distinguish between ASC and physician bills.

Approved Surgical Procedures:

According to CMS, only certain approved treatments can be performed in an ambulatory surgical center billing guidelines setting. This list includes:

Non-emergency, life-threatening operations

Procedures that cannot be performed safely in a physician’s office

Elective procedures

Urgent procedures

Best practices for avoiding critical errors:

Here are some of the best strategies for avoiding serious errors in ambulatory surgical center billing

It is often recommended to study the entire surgical report instead of just considering the procedure heading while coding.

Complications may cause an arthroscopic surgery to be converted to an open procedure. It should only be considered an open procedure for billing. Many coders accidentally bill for both operations, which is incorrect.