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Showing posts from June, 2025

The #1 Reason ASCs Lose Revenue from Medicare Claims (And How to Fix It)

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Ambulatory Surgical Centers don’t lose Medicare revenue because of low case volume. They lose it because of one recurring, preventable failure: Incorrect coding and documentation for Medicare’s ASC-specific payment rules. This single issue triggers denials, underpayments, delayed reimbursement, and permanent write-offs — especially at year-end. If your ASC’s Medicare revenue feels unpredictable, this is why. The #1 Revenue Killer: Not Billing Medicare the “ASC Way” Medicare does not treat ASCs like hospitals or physician offices. Yet many ASCs still: Use hospital-style assumptions Miss ASC-only payment rules Underestimate Medicare’s bundling logic The result? Claims get paid less than expected — or not at all. Where Medicare ASC Claims Go Wrong 1. Incorrect CPT eligibility for ASC payment Not every CPT code is payable in an ASC setting under Medicare. Common mistakes: Billing procedures not on Medicare’s ASC approved list Assuming “covered in hospital” = “covered in ASC” Missing annual...
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Revenue Leakage in Large Medical Practices: Causes, Risks & How to Fix It

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 In large medical practices, managing complex workflows and diverse specialties brings significant operational challenges. Among them, revenue leakage is one of the most financially damaging—and often overlooked—issues. But what exactly is revenue leakage, and how can large healthcare groups identify and correct it before it affects their bottom line? What is Revenue Leakage? Revenue leakage refers to the loss of potential income due to inefficiencies in the billing cycle , coding errors, missed charges, or poor follow-up processes. For large practices with high patient volume, even small gaps in billing or documentation can add up to thousands of dollars in monthly losses . Top Causes of Revenue Leakage in Large Practices Incomplete or Inaccurate Documentation Missing clinical notes or unclear provider entries lead to under-coding or claim denials . Missed Charges Services provided but not captured due to lack of charge capture protocols or communication breakdowns. ...
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Location: XV46+4V Cathedral, CO, USA
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Neurology Billing Optimization: Don’t Miss Out on Reimbursement

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 In the complex world of medical billing, neurology practices face some of the most intricate reimbursement challenges . From highly specialized procedures to evolving coding updates, missing even one step in the billing process can cost practices thousands in lost revenue. So, the question is— are you capturing all your reimbursement opportunities, or are they slipping through the cracks? The Unique Challenge of Neurology Billing Neurology involves detailed diagnostic procedures, cognitive assessments, and a range of services that span both outpatient and inpatient settings. However, the complexity of this specialty makes it particularly vulnerable to: Under-coding of evaluation and management (E/M) services Overlooking separately billable procedures Inaccurate use of modifiers Incorrect documentation for time-based coding Claim denials due to lack of medical necessity Missed Opportunities = Lost Revenue Many neurology practices unknowingly leave money on t...
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Location: QFR8+VQ Abbeyville, CO, USA
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A Complete Guide to Primary Care Billing

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  Primary care practices form the front line of healthcare delivery, providing a broad spectrum of services — from preventive care and routine screenings to chronic disease management and urgent concerns. With this diversity comes billing complexity that requires careful attention to detail, accurate coding, and a clear understanding of payer policies. This guide explores the essentials of primary care billing , helping you understand key components, coding practices, and common challenges. What Makes Primary Care Billing Unique? Unlike specialty practices focused on specific areas, primary care covers: Preventive care (annual check-ups, immunizations) Acute care (infections, injuries) Chronic care (diabetes, hypertension) Screenings and counseling Minor procedures Because these services are often delivered in a single visit, billing must accurately reflect each component — sometimes with multiple codes and modifiers. Core Components of Primary Care Billi...
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Location: United States
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