Expertly guiding you through Medical Billing with ease, simplicity, and confidence.
Medical billing is the process of preparing and submitting claims to insurance companies to receive payment for healthcare services. For example, ...
Answer: A claim is a request for payment sent to an insurance company, while a bill is the statement sent to ...
Answer: EDI stands for Electronic Data Interchange, which is the electronic exchange of medical data between healthcare providers and insurers for ...
Answer: A claims adjuster reviews medical claims to determine whether they should be paid, how much should be paid, and whether ...
Answer: Medicare is a government-provided insurance program for people aged 65 and older, and for some younger individuals with disabilities. Example: ...
Answer: RA codes explain the status of a claim on the remittance advice, indicating whether a claim was paid, denied, or ...
Answer: The CMS-1500 form is used by healthcare providers to submit claims to insurance companies, primarily for outpatient and professional services. ...
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 ...
Answer: A patient ledger is a detailed account of all financial transactions related to a patient’s care, including services, payments, and ...
Answer: A clean claim is one that is error-free and meets all the payer’s requirements, leading to prompt processing and payment. ...
Answer: An EOB is a statement sent to the patient, explaining how much the insurance company paid and what the patient ...
Answer: Medical necessity ensures that the treatments provided are necessary for the diagnosis or treatment of a patient’s condition and are ...
Answer: DRG stands for Diagnosis-Related Group, a system used by hospitals to classify inpatient stays based on diagnoses and procedures, which ...
Answer: A charge is the amount billed to the insurance company or patient for services rendered, while a payment is the ...
Answer: The NPI (National Provider Identifier) is a unique identification number for healthcare providers, used for billing and other transactions with ...
Answer: A clearinghouse is an intermediary that reviews and processes claims submitted by healthcare providers before they are sent to ...
Answer: A contractual adjustment is the amount a healthcare provider reduces their charges based on an agreement with the insurance company. ...
Medical billing uses various software tools such as: Electronic Health Records (EHR): Systems like Epic and Cerner help record patient information. ...
Answer: HCPCS stands for Healthcare Common Procedure Coding System, which includes codes for services, procedures, and medical supplies not covered by ...