Healthcare IT Blog

Molecular diagnostics continues to change what is possible in medicine. Genetic testing, next generation sequencing, biomarker testing and other advanced diagnostics are giving clinicians increasingly sophisticated information to help diagnose disease, guide treatment and support precision medicine.

Ophthalmology billing is some of the most code-dense work in medicine. One busy clinic day can mix eye exam codes, E/M visits, imaging, injections with drug codes, and surgery inside a 90-day global period, and every one of them needs the right eye, the right modifier, and documentation to back it up.

A counselor finishes back-to-back sessions and still has six treatment plans to update before the day ends. The billing team, three desks away, is fighting a stack of denials on claims for sessions that happened weeks ago. Neither problem is really about effort. Both trace back to the same source: behavioral health billing runs on rules that a general medical billing process was never built to handle.

Payroll is due Friday. Your CFO is looking at a receivables report where a third of the balance is more than 60 days old, most of it tied to per diem claims for residential treatment stays that ended weeks ago. The clinical work happened. The cash has not.

Losing revenue between the order and the deposit? See how ADS laboratory billing software checks claims before they go out. Your lab just posted its best test volume in three years. Collections didn't keep pace. Somewhere between the order and the deposit, revenue is leaking through modifier errors, LCD mismatches, and claims that never cleared a payer edit. Nobody on staff has time to trace where.

Waiting on authorizations while beds stay full? See how ADS supports enterprise health systems and rural hospitals from one record. A patient is medically ready to move to inpatient rehab. Your case manager is on hold with a Medicare Advantage plan, waiting on an authorization. The bed stays full. The ED backs up behind it. When the answer finally arrives, it's a denial.

Running inpatient status through three disconnected systems? See how ADS supports enterprise health systems and rural hospitals from one record. A patient sits in observation for 36 hours. Your physician is sure the stay needs inpatient care. Your case manager is on the phone with a Medicare Advantage reviewer who disagrees. Three weeks later, the claim comes back denied, and your team starts an appeal from scratch.

Every October 1, the same thing happens to practices that didn't prepare. A code your team has used for years stops working, the claim bounces, and nobody notices until the denial report runs. This year's ICD-10-CM update is smaller than most, which makes it easy to assume you can skip the prep. That assumption is exactly what causes the denials.

Your monthly report lands with 40 metrics on it, and somehow none of them tell you whether the practice is actually healthy. That's not a reporting problem you fix by adding more columns. It's a sign the dashboard is measuring everything except what orthopedics actually needs watched.

Your billing server went down on a Friday afternoon, and your third location couldn't submit a single claim until Monday. That's not a hypothetical for a lot of multi-site orthopedic groups. It's this quarter's actual story, and it's exactly the kind of risk cloud-based RCM was built to remove.