What is Medical Billing?

Medical billing is the process through which a medical practice creates claims and then submits those claims to an insurance company or insurers to get reimbursement for the medical billing services that their physicians provide to the patients. The medical billing process is a daunting task for a medical practice.

This is because numerous claims get denied for several reasons, including missing or inaccurate data, outdated medical coding, duplicate or late submission, improper transcription, no prior authorization, and lack of documentation. The good news is that all these reasons can be corrected and appealed to. In addition, to help medical practices, there are numerous medical billing outsourcing companies in the US. The medical billing company in NY that can help you out is UControl Billing, and they can save you in all the medical billing procedures and techniques.

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What Processes Are Involved In Medical Billing?

There are several steps in the medical billing process, and each stage has its role in assuring that the medical practice gets paid for its services. It should be noted that missing or causing errors in even one of these steps will have a horrible effect on the revenue cycle of your medical practice. Here are the steps that are involved in the medical billing services:

Patient Registration and Appointments

The first step is patient registration. This step establishes financial responsibility for a patient visit. In this step, a medical practice documents the check-in and verifies insurance eligibility. There are medical transcription billing services providers who do it for you. This information is later used by the medical billers to collect necessary co-payments and to find out about the services that the insurance plan of the patient covers.

Medical Coding of Diagnosis, Procedures, and Modifiers

When the patient leaves a medical practice, the responsibility now lies on the medical biller. It is they who translate the reports into diagnosis and procedure codes. Then they perform charge validation and make superbills. This superbill has all the details of the physician’s services to a patient. It is then submitted to the insurer or the payer to get reimbursement.

Generating Claims and Submitting them

When a medical biller creates claims, they first review whether the correct codes are used on it or not, then they ensure that it meets payer and HIPAA compliance standards. After confirming that everything is accurate, the claim is sent to the insurance company to get paid. When the payers receive the claim, they audit and evaluate each claim to accept, deny or reject it before sending the providers a report.

Collection of Patient Payment

Another responsibility of a medical biller includes generating a statement for the patients who owe an outstanding balance with the medical practice. This statement usually contains all the details of EOB (explanation of benefits). After the generation of the statement, if the patient still fails to pay their bills in time, the medical biller then starts a collection process.

What Are The Challenges In Medical Billing?

When a medical practice fails to streamline its medical billing and coding process, they are actually jeopardizing its practice’s financial stability. This is when medical billing company services comes in handy. At this point, a medical practice should consider outsourcing from the best medical billing company in the US. The best medical billing company will help the medical practice fight the common challenges in the medical billing process. Here are the key challenges that a medical practice faces:


Even now, with so much technological advancement in the healthcare industry, a few medical practices still perform their denial management process manually. This manual practice causes numerous human errors and reduced transparency in the medical billing process. It should be noted that even the tiniest amount of wrong or incomplete information about the patient can cause claim denial or rejection, which will create problems for your practice’s revenue cycle.

Claim Denials

Claim denial is one of the biggest challenges a medical practice faces in its billing process. This occurs when a claim is processed, and the payer repudiates it. There are five categories of claim denials. These categories include the following:

  • Soft
  • Hard
  • Preventable
  • Clinical
  • Administrative

The good news is that outsourcing can prevent most denied claims. In addition, more than half of the rejected claims are re-submittable after the corrections.

Lack of Technology

If a medical practice lacks technology, it should be noted that it would be impossible for a practice to manage, prioritize and channel claims effectively. This implies that lack of technology means that the practice will not be able to streamline its denial management and, as a result, will fail to get the payment the patients and payer owe them. Remember, having a knowledgeable staff member is not enough because, without the applicable technology, it would be complex and challenging for the staff to administer and manage claims.

Patient Eligibility Criteria

It would not be wrong to consider this element, patient eligibility, as the primary source of claims denials. This implies that the claim submitted for the payment of service provided to the patient by the provider is not included or covered by the patient’s insurance plan. This is why a practice should have vigilant front office management to ensure that the patient’s insurance plan covers the service being provided.

Lack of Automation

As stated above, many practices still go for manual claim processes, which is the reason for increased turnaround time for claims because manual processes consume a lot of time. In addition, the medical practices that lack automation in their medical billing process also miss out on some incredible services. Advanced technology and software solutions provide customized claim reporting and decision support.

Medical Billing Outsourcing Companies

When a medical practice decides upon in-house medical billing, its staff is responsible for handling all the processes involved in the revenue cycle management and submitting claims for reimbursement. The practice’s staff set charges, collect patient fees and administer the accounts receivable. This makes the staff member busy and exhausted as they already have a lot on their plate. This sometimes compromises the primary duty of the medical practice, which is patient care. At this point, medical billing outsourcing companies come to the rescue.

The best medical billing company is the one that provides medical billing services that manage all the processes involved in revenue cycle management. In addition, it also allows a medical practice to allocate more employee resources to other vital aspects of the practice. They also enable a practice to achieve better payment rates, faster cash flow and increased compliance with healthcare regulations. These are the benefits that practice will get by outsourcing medical billing services:

  • Accelerate Cash Flow
  • Ensure Billing Compliance
  • Less Medical Billing Errors
  • Patient Data Protection and security
  • Fewer management duties
  • Improved satisfaction of patients

Final Verdict!

In order to get the best medical billing services, choose UControl Billing, as they are one of the best medical billing companies in the United States. They have skillful and knowledgeable people who can handle all the medical billing procedures at affordable prices! You can contact them anytime on their website or customer support if you have any medical-related queries.

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