Within the Revenue Cycle Management (RCM) infrastructure of an independent medical or optical practice, the “Insurance Appeal” is often viewed as the ultimate weapon against a denial. When a claim returns from a commercial carrier marked as rejected, a dedicated biller’s immediate instinct is to step into the ring: they look up the policy, draft […]
In the traditional medical or optical practice layout, the front-desk intake and billing departments are frequently misclassified as “clerical overhead.” New hires are often handed a basic login credential, given a brief overview of the practice management software, and expected to execute high-volume data entry based on unwritten “tribal knowledge” passed down by previous employees. […]
An Operational Audit for Practices Who Choose Not to Bill Secondary Insurance In an era of severe inflation and shifting commercial payer regulations, independent healthcare clinics are constantly seeking ways to streamline administrative overhead. To mitigate the severe staffing crisis, some practices have implemented a drastic operational policy: the outright refusal to file secondary or […]
For an independent medical or optical practice leader, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) usually focuses on high-visibility areas: Is our Electronic Health Record (EHR) password-protected? Are our email systems encrypted? Did our staff sign their annual privacy training agreements? However, some of the most severe, frequent, and costly data […]
One of the most common questions front-desk and billing staff run into is simple to ask but not always simple to answer: when a patient has two insurance plans, which one pays first? Getting this wrong is one of the leading causes of coordination of benefits denials. Here’s how payer order actually gets determined. The […]
If you’ve seen a denial code related to coordination of benefits, or “COB,” on an explanation of benefits, you’re not alone. It’s one of the most common — and most preventable — reasons healthcare claims get denied. What coordination of benefits actually means When a patient has more than one insurance plan, coordination of benefits […]