Billing

Background

Navigate the complexities of revenue cycle management with expert insights, best practices, and innovative strategies to optimize billing processes, ensure accuracy and compliance, and enhance financial performance in the healthcare industry.

Welcome to our best-in-class Provider Billing Strategies and Reconciliation Services! At CareOne Consulting, we understand the crucial role of accurate billing practices and reconciliation for healthcare providers, and we're committed to empowering you with tailored solutions that optimize your billing processes and financial performance.

Our comprehensive provider billing strategies and reconciliation services are designed to streamline your billing operations, ensure compliance with regulatory requirements, and maximize revenue capture.

Key Ways Our Clients Utilize Us:

Billing Optimization: Leveraging our expertise, we develop customized billing strategies to enhance revenue capture, minimize denials, and optimize reimbursement for services rendered, ensuring financial sustainability and growth for your organization.
Claims Reconciliation: We conduct thorough reconciliations of your claims data against payer remittances and contracts, identifying discrepancies and resolving issues to ensure accurate and timely payment posting and revenue recognition.
Revenue Cycle Management: Our team collaborates with you to streamline your revenue cycle processes, from charge capture to reimbursement, implementing best practices and automation tools to improve efficiency and reduce revenue leakage.
Coding Compliance: We provide coding compliance audits and education to ensure accurate and compliant coding practices, reducing the risk of audits, penalties, and revenue loss due to coding errors or fraudulent billing practices.
Provider Education and Training: We offer comprehensive education and training programs for your billing staff and providers, empowering them with the knowledge and skills needed to navigate complex billing regulations and optimize revenue capture.

Join the ranks of healthcare providers that have achieved financial success and operational excellence with the support of our provider billing strategies and reconciliation services. Let us be your strategic partner in optimizing your billing processes, maximizing revenue, and ensuring compliance with regulatory requirements.

Related Insights

4/25/24

CMS Finalizes Major Reforms to Medicaid

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released two final regulations that added new requirements for states when operating their Medicaid programs.

4/23/24

CMS Publishes Final Rule on PACE

The Final Rule gives CMS additional grounds on which to deny PACE organizations’ initial and service area expansion applications, imposes immunization requirements on staff who have direct contact with PACE participants, establishes deadlines for reviewing recommendations and scheduling services for PACE participants, and alters the grievance resolution process.

4/1/24

CMS finalizes Medicare Advantage, Part D payment changes for CY 2025

Few surprises or material changes from the advanced notice. Plans may see wildly different impacts based on their population and programs.

3/18/24

MedPAC report slammed by insurers and docs over Medicare Advantage and physician reimbursement

Health plans and providers alike are disgruntled with a new report to Congress released by the Medicare Payment Advisory Commission (MedPAC).

2/9/24

Medicare to cap out-of-pocket spending on Part D prescription drugs at $2,000

A provision in the Inflation Reduction Act will implement a $2000 out-of-pocket cap on Medicare beneficiaries’ prescription drug spending, which could save money for more than one million enrollees when it takes effect next year.

2/9/24

Medicare Advantage headwinds didn't prevent payers from turning a profit in 2023

Though a spike in utilization among seniors slammed payers last year, particularly in the fourth quarter, each of the six major national firms turned a profit in 2023.

1/31/24

CMS Releases Proposed Payment Updates for 2025 MA and Part D Programs

Payers up against slight decline in 2025 Medicare Advantage payments

1/25/24

Humana posts $541 million loss in Q4, blames high Medicare Advantage costs

Humana's stock dipped following the earnings report, prompting the organization to cut its earnings guidance for this year and next.

1/5/24

US managed care companies lagged behind other insurers, S&P 500 in 2023

Shares of US managed care carriers generally underperformed other types of insurers and the wider market in 2023

11/28/23

HHS Proposes Keeping Same Risk Adjustment Policies for 2025, With Some Exceptions

If finalized, these proposals will generally take effect on January 1, 2025, unless otherwise noted.

11/16/23

CMS releases standards and payment parameters for plans on the ACA marketplace

Changes would increase incentives to engage the American Indian and Alaska Native population, whose communities have been underserved.

11/6/23

Wins and losses in the physician fee schedule final rule

Physician pay in final rule is untenable, providers say, as they laud the delay of MIPS policy and extension of telehealth flexibilities.

10/26/23

Former HealthSun exec accused of Medicare fraud resulting in $53 mln overpayment

Prosecutors said that, in order to carry out their scheme, Valle and unnamed co-conspirators obtained physicians' login credentials to add fake diagnoses to patients' electronic medical records.

10/24/23

Three quarters of ACOs in direct contracting model earned savings

The Global and Professional Direct Contracting Model is now ACO REACH.

10/23/23

Medicare Advantage Plans Pulling Back On In-Home Care Supplemental Benefits

Specifically, across EPHRB, SSBCI and VBID authorities in 2024, 867 plans will offer in-home support services (IHSS) as a supplemental benefit, according to ATI. This is a decrease from the 1,308 plans offering this benefit in 2023.

10/16/23

How CMS’ 2024 Risk Adjustment Rules May Affect Palliative Care Companies

The impact on individual palliative care providers will largely be determined by the terms of their current agreements with MA plans and how they apportion risk between the payer and provider entities.

10/13/23

Wellvana to partner with AdventHealth’s Florida network for value-based care transition

Wellvana is exclusively partnering with AdventHealth’s Florida primary care network to aid in its transition to value-based care (VBC) for Medicare and Medicare Advantage patients, starting in January.

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