Medical billing is a complex, multi-step process that requires constant communication between all parties involved. This includes patients, providers and insurance companies, all of which may have different needs or concerns that must be addressed to ensure proper reimbursement.

What is itemized billing?

During patient registration, sometimes known as check-in, medical staff must verify that a patient’s insurance coverage is current and active before providing care or treating a condition. To improve your clean claims rate, consider implementing software that automates and streamlines this step. CollaborateMD can help you increase your clean claims percentage by conducting a virtual audit of each claim before it is sent for payment.

After a patient’s visit, medical coders Embed Partners translate the doctor’s encounter report into codes that a computer system can understand (e.g., Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes). They then create a superbill, which is an itemized form that details the services provided to the patient and submitted to the insurance company for reimbursement. Back-end medical billers then review and edit these superbills to ensure that all charges, revenue codes, CPT and ICD codes, modifiers and other required information is present. They also perform a process called “claims scrubbing” to ensure that each claim is error-free and ready for submission.

After a claim is submitted to the insurance company, front-end and back-end medical billing employees must track payments as they are received (e.g., balancing direct deposits against remittance advice, matching payment data with outstanding patient balances and sending out statements). If a claim is rejected or denied, medical billing professionals must work with the insurance payer to resolve the issue. A recent Sermo poll found that 26% of physicians indicate time saving as the main reason they outsource their medical billing and coding. CareCloud is a good choice for smaller healthcare organizations that outsource all or part of their RCM, and it offers an advantage over other medical billing services in that its PMS-agnostic structure means that you can use your preferred practice management system (PMS).

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