Expertly guiding you through Medical Billing with ease, simplicity, and confidence.
Answer: A contractual adjustment is the amount a healthcare provider reduces their charges based on an agreement with the insurance company. ...
Answer: An appeal is a request made to an insurance company to reconsider a denied or underpaid claim. Example: A provider ...
Answer: A medical coder assigns codes to procedures and diagnoses, ensuring that the correct services are billed to the insurance company. ...
Answer: A clearinghouse acts as a middleman between healthcare providers and insurance companies, processing claims to ensure accuracy before submission. Example: ...
Submission: The biller submits the claim with the appropriate codes. Review: The insurer checks for accuracy. Adjudication: The insurer decides the ...
Answer: A claim denial occurs when an insurance company refuses to pay for a service, usually due to errors or issues ...
Medical billing is the process of preparing and submitting claims to insurance companies to receive payment for healthcare services. For example, ...
Answer: Medical necessity ensures that the treatments provided are necessary for the diagnosis or treatment of a patient’s condition and are ...
Answer: A clean claim is one that is error-free and meets all the payer’s requirements, leading to prompt processing and payment. ...
The NPI is a unique identifier for healthcare providers. For example, a physician with NPI 1234567890 is easily recognized in the ...
Common errors include: Incorrect coding: Like using 99213 instead of 99214 for a complex visit. Duplicate claims: Submitting the same claim ...
Answer: A clearinghouse is an intermediary that reviews and processes claims submitted by healthcare providers before they are sent to ...
Answer: A medical biller submits claims to insurance companies, follows up on unpaid claims, and ensures that healthcare providers are paid ...
Medical billers must ensure: Accuracy: Correctly coding and billing for services. Transparency: Communicating billing practices clearly to patients. Confidentiality: Protecting patient ...
An ICD-10 code classifies and documents diseases and conditions. For instance, I10 is the code for essential hypertension. These codes are ...
ICD-10: For example, J45.40 is used for moderate persistent asthma. CPT: For example, CPT 99213 is for an outpatient office visit. ...
Answer: In-network providers have a contract with an insurance company, which results in lower costs for patients. Out-of-network providers don’t have ...
Answer: Medicare Part A covers hospital services, such as inpatient care, while Part B covers outpatient services, including doctor visits and ...
Answer: A patient ledger is a detailed account of all financial transactions related to a patient’s care, including services, payments, and ...
Review the denial: Check for errors or missing information. Gather documentation: Collect supporting documents, like lab results. Submit the appeal: Send ...