Blogs

Book Blog

Credentialing in Medical Billing Systems

Credentialing in medical billing is crucial for ensuring patient safety and maintaining the quality of care provided by healthcare providers. This process involves verifying providers’ qualifications, competence, and eligibility, playing a vital role in effective revenue cycle management. In 2021, the Credential Management Solutions Market had a valuation of USD 833.45 Million. Projections indicate that it is expected to reach USD 2526.34 Million by 2030, experiencing a compound annual growth rate (CAGR) of 17.7% from 2022 to 2030. The rising cyber threat risk has spurred demand for skilled experts, credential management solutions, and IT security compliance software in businesses and organizations. (Credential Management Solutions Market Size, Share, Trends & Forecast, 2023) Figure 1. Global Credentialing Management Solutions Market https://www.verifiedmarketresearch.com/product/global-credential-management-solutions-market-size-and-forecast-to-2025/ Medical Billing Systems in Credentialing Medical billing systems are critical components of healthcare operations. They are used to submit and follow up on claims with health insurance companies to receive payment

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Book Blog

The Network Effect

People handle adversity differently; some break down sooner than others. When a team focused on a common goal faces adverse conditions, dissent among some team members precludes them from reaching a shared goal. Under extreme conditions, a mutiny isn’t just mission-critical—it can leave everybody dead. The famous explorer Ernest Shackleton, best remembered for his Antarctic expedition of 1914–1916 in the ship Endurance, managed such risks by assigning the whiny, complaining crew members to sleep in his own tent and share the chores with him. Clustering the “complainers” with him minimized their negative influence on others, and this helped his team survive and accomplish their goals. Medicare Vs. Private Payers It’s essential to acknowledge the contrasting dynamics between Medicare and private payers. Medicare, as a government-backed program, follows distinct regulations and reimbursement structures, while private payers operate in a competitive market with more flexible terms. The negotiation strategies and considerations may

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Book Blog

Are You Someone’s Hero?

In the last chapter we talked about hunger and the drive that must exist between all members of a patient community, including the patients themselves, but what about the patient’s need for a mentor? Remember in previous chapters we talked about how Joseph and Bonnie’s dispositions not only affected their ability to treat effectively but also resulted in lost patients? Patients, because they are people, respond and react to the emotions they receive. We don’t always react in the expected way, but that has more to do with the person interpreting than the person reacting. So how do we set ourselves up so that when we aren’t having the best day ever and performing at our peak state, our patients still receive the best care possible? The answer is heroism. And no, I’m not talking about superhero heroism like we see in the movies today. I’m talking about the heroism

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Book Blog

Are You Hungry?

Great, now Reuven wants to know if I’m hungry. Don’t worry, we’re not talking about hunger pains or anything like that. I’m talking about drive, the hunger to stop at nothing to succeed. But I’m also not talking about it in the most general sense. In other words, we’re not talking about all those Youtube videos dealing with motivation, drive, and hunger. I’m talking about the hunger unique to healthcare that is required to create a thriving practice. I’m talking about community hunger. When you want to put together a thriving patient community, regardless of specialty, of course, it’s critical that both you, your staff, and your patients feel a certain hunger. Gone are the days of thriving practices where patients simply receive care. Today, a thriving practice depends on the teamwork built between a patient and the staff in the office. However, anytime you have a team, you need

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Book Blog

Straight-Through Billing  

Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight-Through Billing (STB) addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists on exceptions only. An STB process flags problems, routes them for follow-up, and enables online correction and resubmission. The STB methodology implements billing service transparency and focuses management on strategic process improvement opportunities.  Straight-Through Billing integrates the billing process into the practice management workflow, automates the vast majority of transactions, focuses manual labor on exceptions, and establishes a process for continuous improvement.   Remember:  Straight-Through Billing offers a comprehensive approach to improving the billing process, integrating various components, and promoting continuous improvement.    Practice Management Integration  First, integrated practice management and billing workflow connects patient scheduling, medical record management,

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Book Blog

AI in Medical Billing

AI has revolutionized many different industries, and healthcare is no exception. In recent years, medical billing has benefited greatly from using Artificial Intelligence.   Where are the major pain points in healthcare today? 1-Patients:  A major challenge today is long wait times. In 2022, the average wait time for a physician appointment in the 15 largest U.S. metro markets is 26 days [1]. The longer someone has to wait, the higher the risk of complications or possibly more serious health issues arising.   Some possible solutions to address this problem include  use of telemedicine involves providing medical consultations and services remotely using technology such as video conferencing.   increasing the number of healthcare professionals in practice,  streamlining administrative processes and  improving patient communication and education to help prevent avoidable illnesses and hospital visits.   2-Physicians:  Physician burnout is affecting a high percentage of physicians. 62.8% of physicians experienced at least one

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Book Blog

Claim Denial Management

Partial denials cause the average medical practice to lose as much as 11% of its revenue (Capko, 2009).  Payers are known for denying claim payments for legitimate reasons (provider-generated errors) and arbitrary reasons, motivated by the inherent benefits of controlling the float for the maximal time (Stahl). Systematic denial management must address both kinds of errors.  Denial management is difficult because of the (intentional) complexity of denial causes, payer variety, and claim volume.  Systematic denial management requires measurement, early claim validation, comprehensive monitoring, and customized tracking of the appeals process. According to a survey by the Medical Group Management Association (MGMA), 69% of organizations reported a significant increase in denials, averaging 17%, in 2021 alone. These findings are further supported by additional alarming statistics  (Zipple, 2023):   In 2021, claim denials surpassed 48 million (Kaiser 2023). On average, nearly 20% of all claims are denied, and shockingly, up to 60%

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Book Blog

Computer-aided Patient Scheduling

Without a computerized scheduler, a practice has less than a 2% chance of earning the title of a “better-performing practice,” according to the Medical Group Management Association. Computerized scheduling helps decrease service costs, provide fairness in service delivery, increase patient satisfaction, and reduce waiting times (Zhang et al., 2019). A massive investment in scheduling features across a wide spectrum of billing products indicates the importance of computerized scheduling. Convenience and front office efficiencies are two obvious benefits of a computerized scheduling system; without them, the only manual way to find out if a specific patient has a scheduled appointment is to flip through the appointment book page by page. Worse, manual scheduling hurts both patient satisfaction and practice financial performance because of scheduling inconsistencies and unbilled (and therefore unpaid) visits. But the benefits of integrated computerized scheduling stretch far beyond convenience, front office efficiencies, and better charge follow-up of stand-alone,

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Book Blog

Value Adding for Maximum Profit

I love this topic because it’s easy to miss the mark, especially since so many consultants and marketing firms misappropriate this term and don’t actually coach on value-adding. The idea of value-adding has come under scrutiny in light of the current trend of corporate acquisitions of primary care clinics and the rising patient expectation for comprehensive, patient-centered treatment (Abelson, 2023). This is because of how the healthcare industry is changing. There is a growing need to separate actual value addition from empty rhetoric when corporate companies acquire primary care operations. The demand for genuine, efficient value-adding solutions has never been greater due to the rise in patient expectations for a comprehensive healthcare experience. Don’t get me wrong, plenty do an absolutely amazing job, and their clients see great results, but more often than not, disaster strikes. Especially in the case of Joseph and Bonnie… When Joseph and Bonnie opened their

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Credentialing in Medical Billing Systems

The Network Effect

Are You Someone’s Hero?

Are You Hungry?

Straight-Through Billing  

AI in Medical Billing

Claim Denial Management

Computer-aided Patient Scheduling

Value Adding for Maximum Profit

Change Management – Switching Your Billing Systems

Why ClinicMind?

Factoring

Tasks, Checklists, and Problem Management

Fifteen Criteria for Best SaaS

Patient Loyalty

Has the Provider’s Compensation Kept Up With the Economy or Healthcare Costs?

FinTech Platforms to Manage Healthcare Networks Acquisition Risks

ClinicMind External NewsLetter vol 3

Why Private Practices Need Insurance Denial and Appeals Management 

Navigating Insurance Audits and Compliance 

Using Analytics to Optimize Insurance Management 

Insurance Industry Trends and Changes: Keeping Your Practice Up to Date

Creating a Fee Schedule for Your Private Practice

Coding and Billing Best Practices

ClinicMind External NewsLetter

Maximize Private Practice Revenues with Billing Efficiency

Positive Reputation Management Strategies for Private Practice Success

How to Structure Your Private Practice for Maximum Efficiency

How to Create a Successful Private Practice Business Plan

Best Practices for Developing a Strong Referral Network in Private Practice

Mobile Apps for Private Practice: Tips and Tricks for Success

How to Keep Patients Engaged in Their Healthcare

How to Get Credentialed for Insurance

How to Focus More on Patient Care

Content Strategy Tips for Private Practice Chiropractors

Blogging for Private Practice: Must-Know Tips and Tricks

Monthly New Features Highlights – January 2023

Taking Your Private Practice to the Next Level with a Website

Promoting Your Private Practice with Social Media

Navigating Self-Employment Taxes and Other Tax Issues for Private Practices

Public Relations for Private Practices

Choosing the Right Corporate Structure: S Corp or C Corp?

Google for Business for Private Practices

Monthly New Features Highlights – December 2022

Does My Private Practice Need a Website

Battling Insurance Claim Turbulence

Questions to Ask Before Switching EHRs Part-2

Facing Insurance Claim Adversity

These are the questions you should ask before switching EHRs

Switching EHRs: The Need for Change and the Challenges it Brings

Finding Solutions to Insurance Claim Problems

This is what you need to know about getting insurance claims paid

What the CURES Act Means for EHI and Information Sharing

The New 988 Mental Health Crisis Line

Marketing your private practice makes smart business sense

What are insurance panels?

Should I go into private practice?

Internal Vs External Billing

What to Consider When Setting Your Therapy Rates

Attracting New Chiropractic Patients 101: Part 1 Social Media

How You Can Avoid Common Costly Mental Health Billing Errors