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Welcome to the Medical Billing Page!

Dedicated to understanding and implementing Best Practices in Medical Billing, this resource focuses on Claim Denial Management with practical how-to-do-it insights and tips from veteran billers. It addresses in depth each aspect of the medical billing cycle: Pre-visit Screening, Understanding Coverage, Check-in, Coding Essentials, Claim Management, Working the Revenue Cycle, Denials & Appeals, and Collections; along with an overview of 'what is medical billing' for new comers.


What is Medical Billing & How To Do It!


Overview

Medical billing encompasses all the activities required for doctors or other healthcare practitioners to get paid by either the patient or reimbursed by an insurance carrier. Most ostensibly it involves the preparing of medical claims to be sent to health benefit payers such as Medicare, Medicaid, BlueCross or BlueShield, etc. 

Submitting medical claims to an insurance carrier and managing the overall claim process is more complicated than filing someone's Federal Income Taxes; as there can be more than five different entities sharing the responsibility to pay for the medical treatment of a patient! 

While it can take time and experience to become a good medical biller, it's helpful if one begins with a clear grasp of what a 'Medical Biller' is supposed to do, and how they are supposed do it. This series of ten articles takes an in-depth view at how the best medical practices view, organize and execute the tasks associated with the entire medical billing process. For folks who like diagrams, here's a easy schematic depicting just how involved the whole medical billing revenue cycle can be.

 


The 10 Best Practices Every 
Medical Biller Should Know!

#1        #2        #3        #4        #5        #6        #7        #8        #9        #10

#1   Checking Eligibility
#2   Understanding Coverage
#3   Check-in (administrative)
#4   Medical Coding Essentials
#5   Sending Claims Electronically
#6   Revenue Cycle Management (RCM)
#7   Follow-Up & Adjudication
#8   Pay & Adjust, Secondary Claims
#9   Denials & Appeals
#10  Collections

 


# 1  Medical Billing Best Practice Number One  

Pre-Visit Screening:  -  Why Eligibility Verification Matters

As a Medical Biller, your objective in pre-screening insurance eligibility is to determine patient responsibility before check-in; ideally, before the patient ever leaves their home to go to their medical appointment. You need to know what's covered and what's not, preferably before the patient arrives.


 



# 2
 
Medical Billing Best Practice Number Two  

Understanding Coverage:  -  Benefits Coverage (for dummies)

Why does every single insurance carrier report different information and report it in a different format? Making sense of health insurance benefits means the difference between getting paid or not getting paid. Here we seek to unravel the mystery of understanding benefit eligibility reports.


 


# 3  Medical Billing Best Practice Number Three  

Check-In (administrative):  -  Do's and Don'ts at Check-in / Handling Cash

So much can go so right, and so much can go so wrong, at check-in. Clear policies and adherence to those policies are the key to success. In good practices you'll see many common denominators. Here are a few of them.


 


# 4  Medical Billing Best Practice Number Four  

Coding Essentials:  -  Claim Preparation / Medical Coding / Coding Utilities

Nothing pays like experience and it is doubly true when you begin preparing claims for filing. Medical Coding is synonymous with who and what a medical biller is. Here are a few thoughts from veterans of the craft.




# 5  Medical Billing Best Practice Number Five  

Managing Claims:  -  Filing Claims Electronically / Scrubbing for Errors

Everything you never wanted to know about claim transmittal and claim errors!


 


# 6  Medical Billing Best Practice Number Six  

Working the Revenue Cycle:  -  The Claims Have Been Sent, Now What?

Once a claim has been sent, it kicks off the revenue cycle and the sand of time begins running down the hour-glass. Here's the nuts and bolts of RCM, and how smart billers organize themselves and their tasks.


 


# 7  Medical Billing Best Practice Number Seven  

Working the Revenue Cycle (part B):  -  Adjudication, Follow Up, Re-submittals

Adjudication, insurance follow-up and avoiding claim resubmittals, could be considered the necessary core competencies of a Medical Biller. Here's what all three are about and how to do them.




# 8  Medical Billing Best Practice Number Eight  

Working the Revenue Cycle (part C):  -  Payments, Adjustments, Secondary Claims

A Medical Biller needs to enter Payments & Adjustments as soon as payments come in so that Secondary claims can be filed in a timely manner. It also provides the practice with current status on patient balances and insurance balances, which is needed to manage cash flow.



# 9  Medical Billing Best Practice Number Nine  

Denials & Appeals:  -  In a Perfect World

Let's face it, insurance companies increase their profitability by denying claims and sometimes they'll deny them out-of-hand for no legitimate reason just to manage their cash-flow. So if you have a health benefit payer that insists on a fight, well then let's roll up our sleeves; here's what to do.




# 10
 
Medical Billing Best Practice Number Ten  

Collections:  -  Patient Balances : Statements, Payment Arrangements, Collections

As a Medical Biller your aim is to avoid ever having unpaid patient balances in your account receivable reports, but in the real world, here's what to do when you inevitably get them, and expert advise on how to avoid them.


 

 

NEXT #1   Checking Eligibility
#2   Understanding Coverage
#3   Check-in (administrative)
#4   Medical Coding Essentials
#5   Filing & Managing Claims
#6   Revenue Cycle Management (RCM)
#7   Follow-Up & Adjudication
#8   Pay & Adjust, Secondary Claims
#9   Denials & Appeals
#10  Collections

 


Medical Billing - How to Do It! 10 Best Practices. 

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