The Patient-Centered Medical Home (PCMH) is a healthcare delivery model designed to improve the quality, efficiency, and patient experience of primary care. It focuses on providing comprehensive, coordinated, and accessible care that is centered around the patient’s needs and preferences. Key Principles of PCMH Comprehensive Care:PCMH provides a wide range of healthcare services, including prevention, […]
MIPS (Merit-based Incentive Payment System) is a program established by the Centers for Medicare & Medicaid Services (CMS) designed to promote quality and value in healthcare. It adjusts Medicare payments to clinicians based on their performance across several categories, encouraging providers to deliver high-quality, efficient care. What is MIPS? MIPS consolidates several previous programs—like the […]
Accounts receivable (A/R) is the lifeblood of any medical practice’s financial health. However, over time, unpaid or “old” accounts receivable—those claims or patient balances outstanding for 90 days or more—can accumulate, tying up valuable resources and masking the true financial performance of your practice. Old A/R not only affects cash flow but also increases administrative […]
For small medical practices, managing the revenue cycle effectively is crucial to maintaining financial stability and focusing on patient care. However, the complex process of billing, coding, claim submission, and payment collection can often overwhelm limited staff and resources. Streamlining the revenue cycle helps reduce errors, accelerate reimbursements, and improve cash flow — all essential […]
In the complex world of healthcare billing, verifying a patient’s eligibility and benefits before providing services is a crucial step that can save time, reduce claim denials, and improve the financial health of a medical practice. Eligibility and benefits verification is the process of confirming a patient’s insurance coverage, including what services are covered, copay […]
Modifier 59 is a powerful tool in medical billing used to indicate that two or more procedures or services, which are usually bundled together, are distinct and separately billable. However, because of its complexity and potential for misuse, Modifier 59 is often a red flag during payer audits and can lead to denials or delays […]