Understanding Medical Billing

Healthcare billing services ensure that the facility gets reimbursement for the work they perform. An experienced biller can optimize revenue performance for a healthcare facility. 

Medical billing involves the submission and follow-up of claims with health insurance providers to get paid for solutions offered by the medical caregiver. The process translates medical service into a billing claim.

Specialists dealing with healthcare billing services are in charge of ensuring that the revenue cycles of health facilities run without glitches. When a solution is rendered, a coder attaches a code to it. The procedure and diagnosis codes are obtained from different medical record documentation like lab and radiology results, transcription from physician notes, and so on. Medical billers are responsible for collecting all information surrounding the bill, including charge entry, payment posting, claims transmission, patient follow up, and patient follow-up. They also keep constant communication with healthcare providers to clarify diagnoses or get any other relevant information.

In a nutshell, medical billing service includes:

  • Claim generation and submission
  • Payment posting and processing
  • Carrier follow-up
  • Patient invoicing and support
  • Collection company transfer solutions

These solutions are at the core of medical billing. What sets the billing service apart from in-house staff is usually the ability to follow-up and pursue of denied claims are the two areas. What’s more, billing service providers often provide medical coding, credentialing, insurance eligibility verification, transcription, and appointment scheduling along with the billing services.

Note that, like any other services, physicians also need to find a provider who’s qualified to handle the task at hand. A few things to watch out for include level of service, use of technology, industry experience, capacity to take on new clients, and pricing models.

Medical billing process

Patient check-in: When a patient comes in for treatment, their demographic data, including insurance payer, policy number, and other essential details needed for a claim, are keyed in.

Member verification: Since insurance information can change, providers need to ensure that a member is eligible every time they render a solution. The eligibility and verification step also allows providers to get benefits and authorization data.

Entering of charges: This involves the keying in of solutions that the patient receives and includes linking the right medical codes to solutions offered during the visit.

Coding claims: This process allows the insurance payer to know the injury or illness of the patient as well as the method of treatment. 

Submission: Once everything is in check, the third-party is sent for payment to the insurance provider. To place the claims effectively, the billing company should have access to (or be aware of) a lot of information for every insurance firm.

After the claim goes through the clearinghouse successfully, the insurer reviews it and either accepts or rejects all or a part of the claim. In the case of the latter, the providers need to review remittance advice codes to establish whether and how they can rectify and resubmit the claim or charge the patient.


The billing process takes time and resources, and any slight error might lead to denial and a lot of time wasted. Working with a billing service can help streamline the process and increase efficiencies relating to healthcare reimbursement.

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