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What is Medical Billing?

Feb 9

We can describe medical billing as the process through which a medical practice creates claims and then submit those claims to an insurance company or insurers in order to get reimbursement for the medical 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This is because numerous claims get denied due to several reasons, including missing or inaccurate data, outdated medical coding, duplicate or late submission, improper transcription, no prior authorization, and lack of documentation.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 best medical billing company that we would recommend is UControl Billing. In order to know why? Keep on reading! 

In the past, the process of medical billing used to run using hand-written documents or, in other words, via paper-based means, but with the emergence of advanced technology in the medical industry, this process has transformed into an electronic one! The best medical billing company in the US will use this advanced technology for providing the best services as well as for saving your medical practice’s time, money, and energy! 

What Processes Are Involved In Medical Billing? 

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

Patient Registration

The first step is patient registration. Basically, this step establishes financial responsibility for a patient visit. In this step, a medical practice documents the check-in and also verifies insurance eligibility. There are medical transcription billing services providers which do it for you. This information is later used by the medical billers in order to collect necessary co-payments as well as 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 services that the physician provides to a patient. It is then submitted to the insurer or the payer in order 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 ensuring 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 in order to accept, deny or reject it before sending the providers a report. 

Collection of Patient Payment

Another responsibility of a medical biller includes the generation of 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 their medical billing and coding process, they are actually jeopardizing their practice’s financial stability. This is when medical billing outsourcing comes in handy. At this point, a practice should consider outsourcing from the best medical billing company in the US. The best medical billing company will help the medical practice in fighting the common challenges that occur in the medical billing process. Here are the key challenges that a medical practice faces: 

Claim Denials

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

  • Soft
  • Hard
  • Preventable
  • Clinical
  • Administrative

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


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

Patient Eligibility

It would not be wrong to consider this element, patient eligibility, as the primary source of claims denials. This basically implies that the claim submitted for the payment of service that is 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 so that it could be ensured that the service being provided is covered by the insurance plan of the patient.  

Lack of Automation

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

Lack of Technology

If a medical practice lacks technology, it should be noted that it would be impossible for a practice to effectively manage, prioritize and channel claims. 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 hard and challenging for the staff to administer and manage claims. 

Medical Billing Outsourcing Companies

When a medical practice decides upon in-house medical billing, it is their staff who is responsible for handling all the processes involved in the revenue cycle management and submitting claims for reimbursement. It is the practice’s staff who set charges, collect patient fees, and administer the accounts receivable. This makes the staff member really busy and exhausted as they already have a lot on their plate. This sometimes compromises the main 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 to that, outsourcing medical billing services also allows a medical practice to allocate more employee resources to other important aspects of the practice. They also enable a practice to achieve better payment rates and faster cash flow and increase compliance with healthcare regulations. These are the benefits that practice will get by outsourcing medical billing services: 

  • More Focus on Patient Care
  • Reduced Administrative Duties
  • Enhance Cash Flow
  • Reduce Billing Errors
  • Improve Patient Satisfaction
  • Secure Patient Data
  • Ensure Billing Compliance

In order to get the best medical billing services, choose UControl Billing as they are USA's best medical billing company. To know more about this medical billing company, visit their website and take advantage of their affordable services!