Resources for Providers, Billing and Administrative Staff

What is Denial Management?

Posted by Alok Prasad

Denial Management - Definition, Goals and Challenges

Denial Management is the process of systematically investigating each denial, performing root cause analysis of why each claim was denied, analyzing denial trends to uncover a trend by one or more insurance carriers,and redesigning or re-engineering the process to prevent or reduce the risk of future claim denials.

Many physician practices forgo thousands of dollars annually in revenue through denied healthcare claims. These denials typically stem from a lack of strong denial management policies and procedures.

Essentially, you want to lessen the number of denials by seeking the root cause for it as well as the coded cause. Every instance where no payment or lower than expected payment occurs must be investigated.Doing this is an essential part of optimizing your revenue cycle.

These numbers paint a clear reason as to why denial management is an imperative process for physician practices:

An estimated two-thirds of all denied claims are recoverable.


 

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Learn all about Electronic Prescribing of Controlled Substances (EPCS)

Posted by Alok Prasad

What Is a Controlled Substance?

Prescription drugs are those drugs that are prescribed by a provider for a specific person and bought at a pharmacy. These are regulated by FDA. Prescription drugs are classified into two categories:

  1. Non-controlled prescription drugs
  2. Controlled prescription drugs

Non-controlled drugs are prescribed to treat medical conditions such as high blood pressure, diabetes, and bacterial infections. Such prescriptions are not subject to some of the same limitations as controlled substance prescriptions.

Controlled substances are drugs or medications (whether prescription or illicit) considered to have the highest misuse and use disorder potential and therefore have the strictest regulation and prescription requirements on a federal and state levels. They are regulated by the Controlled Substance Act (CSA) which was enacted as part of the Comprehensive Drug Abuse Prevention and Control Act of 1970. To prescribe controlled substance medication, a clinician must have a DEA (Drug Enforcement Administration) license; to fill a prescription, a pharmacist must also have a controlled substance license.

 

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What is e-Prescribing?

Posted by Alok Prasad

What is Electronic Prescribing?

e-prescribing is defined as “the computer-based electronic generation, transmission, and filling of a prescription, taking the place of paper and faxed prescriptions.” Intending to improve the quality of patient care, e-prescribing gives healthcare providers the ability to send prescriptions electronically from the point of care directly to the patient’s pharmacy.

Using specialized software systems that can be accessed from both desktops and mobile devices, this approach offers a variety of benefits that include:

  1. Reduction of medication errors
  2. Improved convenience for providers, patients, and families
  3. Reduction of healthcare costs

 

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What are Electronic Health Records (EHR)?

Posted by Alok Prasad

What is EHR?

EHR Definition

An Electronic Health Record (EHR) is an electronic or digital version of a patient’s traditional paper-based chart and offers a comprehensive, real-time and patient centered view of a patient’s medical history maintained by one or more authorized providers over time to authorized set of users. EHRs include all of the key administrative clinical data relevant to that persons care under one of more authorized providers, including demographics, progress notes, allergies, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports, etc.

 

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Electronic Medical Record Systems

Posted by Alok Prasad

What is Electronic Medical Record (EMR) System?

EMR System is an integrated set of interoperable technology components including EMR Software, Practice Management Software, ePrescription, Dashboards, telemedicine, interfaces to labs and clearinghouses, workflow tools, patient portal, etc. - all working seamlessly to help healthcare providers improve patient care, stay compliant and reduce medical costs. EMR systems replace traditional paper-based charts and manual workflows with digital files and electronic transmissions in the physician practice and offer a comprehensive view of a patient’s medical history.

EMR Systems include “all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports".  It is created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization". 

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