Raul Neyra

Reading Time: 3 minutesWhat is Credentialing? Credentialing is the process by which a practitioner’s license, education, training, experience, and other qualifications are verified in order for them to provide care or services in or for a health care organization.  This process’ role is to help maintain standards of quality in the medical community for the benefit of patients. […]

Reading Time: 3 minutesMost of us are used to being billed for a variety of services rendered, such as for plumbing fixes. You receive a bill outlining the work done and you pay it. Simple. However, medical billing isn’t as easy as that. Providers don’t just send a bill to the insurance company and receive payment. It is […]

Reading Time: 3 minutesMedical coding is necessary for physicians to get reimbursed for services rendered. To get paid their contracted rate by insurance companies, physicians have to code procedures accurately to reflect the services rendered.  But the job of coding medical claims is complicated.  There are thousands of codes and compliance rules and you have to be able […]

Reading Time: 3 minutesManaged care brought about so much more administrative work to the healthcare industry than there had ever been before. To make it even more complicated each insurance company has a different set of rules and guidelines that must be followed. What if a patient needs to see a specialist? Or needs to have a procedure […]

Reading Time: 4 minutesMedical claims denials will happen. But how many denials are you getting per month? More than 10%? More than 20%? Not sure?  A recent Healthcare Information and Management Systems Society (HIMSS) survey shows that 3 out of 4 (76%) of healthcare leaders say denials are their greatest challenge. And other research shows that 90% of […]

Reading Time: 4 minutesDo you have insight into your practice’s financial health? Do you know how much of your accounts receivable is older than 60, 90, or even 120 days? MGMA recommends that less than 14% of your A/R should be 90+ days old. They also show that 60 percent of the amount owed by patients is never […]

Reading Time: 4 minutesAre you struggling with outstanding account receivables? Did you know that research shows practices only collect about 12% of outstanding balances at the time of service and collect nothing approximately 67% of the time? Also, it has been shown that the higher the outstanding balance, the less monies are collected. For example, about 40% of […]

Reading Time: 4 minutesIn-house Medical Billing Initially, physician’s offices had a person in-house that handled everything having to do with billing for the practice. This person added to the overhead of the office – about 10 – 12% and handled everything from A-Z in the billing process. General knowledge of codes was all that was needed to ensure […]