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Billing employee frustrated on the phone over denied and rejected claims.

What You Need to Know about Denied and Rejected Claims

Denied and rejected medical claims can erode a significant chunk of your practice’s revenue, especially if you’re not set up to manage them efficiently. The good news is that the majority of rejected and denied claims are preventable and caused by common errors. You can make a big difference in your claim rate by identifying problems in your workflow, educating your team, and using the services of a reliable clearinghouse. Here are 5 important things you should know about how claim errors interrupt your revenue cycle.   The Difference Between Rejected and Denied Claims  Denied and rejected claims are not the same and will

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Optician offering glasses to a patient.

Could Retail Optical Benefit Your Practice?

As an ophthalmology or optometry professional, one of the best moves you can make to grow your practice is to incorporate a retail optical outlet as part of your operations. This move makes sense when you consider that one of the key factors that patients consider when choosing eye care is their health insurance.   As a medical professional, a visit to your practice would be billed under their medical plan instead of their vision plan. However, if your patients require a basic examination or to purchase glasses, contacts, or other vision aids that you prescribe to them, the cost would

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Doctors and billing team working together to submit claims more successfully.

4 Keys to Submitting Claims Successfully

Submitting claims requires an A-list clearinghouse. Let’s face it. The claim management process is quite tasking, and without the right intermediary, getting what is due to you can be an uphill task.  A slight delay or an unsuccessful claim could mean poor cash flow for your organization. In today’s post, you’ll discover what it takes to file a successful claim. We’re persuaded you’ll find this helpful and that it’ll positively influence your bottom line. So, let’s get started!  1. Make Payments a Priority  Cash flow is the bloodline of every successful organization. Without adequate funds, it’s more like a blood clot blocking

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An optometrist performing a routine eye exam on her patient. 

Medical vs. Vision Care Claim Processing

Handling claims regarding optometry and ophthalmology can entail a string of tiny details, including differences between billing to a vision plan versus what you should bill through a patient’s medical insurance. Differentiating between the two can often be a little confusing at first, and that’s okay. To make things easy, let’s review what the differences between both types of claims are, why they’re important, and how you can make handling them a seamless process.   Vision Plans vs Medical Insurance  The average medical health insurance policy covers unexpected emergencies, meaning that routine eye exams, contact lenses and glasses are not considered or covered

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How to Audit Medical Claims

A medical claims audit can prove to be the most valuable tool in your clinic’s compliance arsenal. When properly conducted, an audit can boost your claims accuracy and help your medical billing unfold more efficiently. Whether you choose to conduct your review internally or hire an external auditor, it’s important to understand how to audit medical claims.  The key to ensuring that your audit proceeds smoothly is to first streamline your claims process with a proven clearinghouse such as Apex EDI. Below is a look at the claims auditing process and the role that medical claims software can play in

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Guide to Optometry Billing and Coding

According to the US Center for Disease and Control (CDC), approximately 12 million people in the United States have some form of vision impairment. Another 93 million adults are at a high risk of severe vision loss. With such startling revelations, experts estimate the employment gap for Optometrists to increase faster than most regular occupations in the US. As the demand for optometric treatments rises, practicing optometrists must streamline their billing and coding process to ensure they follow proper procedures.   To help you get started, we have put together a definitive guide about optometry billing and coding.  Billing and Coding for Optometry 

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Are Claims Management Companies Worth It?

The world of insurance claims can be challenging, intimidating, and downright frustrating at times. Between changing regulations, delayed payments, and unresponsive financial institutions, you may find yourself wishing a fairy godmother would swoop in to magically take care of all your claims and deliver all your payments in light speed.  Unfortunately, fairy godmothers don’t exist in the insurance claims world. But for many private practitioners, claims management companies are the next best thing. They have the skills and resources to handle your claims processing from start to finish, helping you to secure payments faster while reducing your stress. In short, hiring a claims

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What is EDI Enrollment and What Are the Benefits of an EDI Clearinghouse?

The introduction of the electronic claims process changed healthcare forever. In a system that was riddled with inefficiencies and inaccuracies due to paper claims management, digital billing offered a solution. For providers looking to eliminate these problem areas in their claims process, EDI enrollment is necessary. Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer. In order to be eligible to submit electronic claims to an insurance company, providers must complete EDI enrollment.  What is EDI Enrollment?  Some payers require EDI enrollment in order for providers to submit electronic

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Why Electronic Claim Submission is Worth Switching For

So, you have a clearinghouse partner. Great. But what if they only offer paper claims for certain payers? Not so great. The ability to submit claims electronically is key to maximizing your revenue stream. If your clearinghouse provider no longer offers electronic claims submission, you might want to consider a change. And don’t worry. It’s easy.  The Benefits of Electronic Claim Submission  When you submit paper claims, a lot can go wrong along the way. Your claims and your organization’s cashflow are at the mercy of postage. And not to mention, the entire claims management process is slowed to a crawl. With

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COVID-19 Medical Claims. What You Should Know.

It is hard to find someone in our current world who is not aware of COVID-19. The entire world was affected by the global coronavirus pandemic and it has been a source of dispute and chaos all while medical researchers and healthcare workers have desperately tried to keep up. When dealing with a health crisis of such a massive scale, it is important that everyone be knowledgeable about keeping safe. For healthcare providers, properly filing COVID-19 medical claims can maintain smooth operations and better patient experiences.    In this article, we speak directly to healthcare professionals and billers submitting claims related

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How to Maximize Telemedicine Billing

Telemedicine is no longer just the future of healthcare. In today’s healthcare climate, it is an absolute necessity. As telemedicine, or telehealth, becomes the norm for healthcare providers, those providers as well as insurance companies will need claim processing software that best optimizes their telehealth billing.   Telemedicine’s Growth  Telemedicine, or telehealth, has come into its own in the last several years. Patients are more connected than ever before. They value online reviews, prefer to make appointments and pay bills online, and want alerts to help them manage their busy lives. With this and recent technological developments, telehealth and mobile functionality are becoming the increasingly dominant choice for healthcare.    Furthermore, in the wake of the COVID-19 pandemic, the demand for telehealth services and coverage has never been higher. Even after the heightened precautions of the pandemic

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8 Benefits of Using a Claims Clearinghouse for Medical Billing

Health insurance has always been a highly debated topic. With more people using a larger variety of health insurance options, we ultimately have more insurance claims to file. Unfortunately, this means medical associations and individual practitioners often find themselves bogged down with more and more paperwork and medical billing can become overwhelming.   Medical claims processing can be a stressful ordeal, so let us help you figure out what you need to know. Schedule a free live demo of Apex EDI today.   How Medical Claims Processing Works  We live in a world where technology is expanding at unbelievable rates. With this massive growth, the way

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How to Prepare Your Practice for Medical Billing During a Disaster

Natural disasters can cause serious problems for medical facilities. When medical providers are inundated with victims or face other outages that impede proper functioning, medical claims are the last things on the mind. Unfortunately, this can cause major disruptions to patient care and revenue streams down the line. However, natural disasters are a part of our world, so it’s wise to have a contingency plan in place just in case. Thankfully, there are steps healthcare facilities can take ahead of time to prepare themselves in the case of the unexpected, preventing the loss of revenue for their hard work.   Let’s take a look at some of the natural disasters that have

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Your Guide to Telehealth Billing

The Mayo Clinic defines telehealth as “the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.” Telehealth is often referred to as “telemedicine,” although it encompasses a broader range of services than remote clinical sessions. Not surprisingly, telehealth has exploded in popularity in 2020, especially in the wake of the COVID-19 pandemic. Of course, even before then telehealth was already an integral part of many health care providers’ service packages, with at least 76% of hospitals connecting with patients and consulting practitioners remotely through advanced

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Why You Need a Medical Billing Clearinghouse for Your Practice

It’s no secret that documents now exist in electronic forms more than paper formats. If you run a medical practice, you undoubtedly have experience with processing medical claims for patients’ medical bills. Filing electronic paperwork reduces the time and effort required to correct and send the claims. With the right medical claims software, you can streamline the business side of your practice and focus on treating your patients. What Is a Clearinghouse? A clearinghouse acts as a polisher for your medical claims, also known as ANSI-X12 837 files. To create the files, you use billing software that picks patient details

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