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Medical Billing and Coding Services for Medical Billing Success!

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What is Medical Billing?

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for medical services rendered.

Thanks to Portiva's medical billing services, our revenue has increased by 20% and we no longer have to worry about the time-consuming process of submitting claims. The team at Portiva is professional, efficient, and a pleasure to work with." ⭐⭐⭐⭐⭐



Medical billing is a necessary process used in the clinical care industry. It consists of medical coding procedures, submitting claims, verifying coverage and payments, and reconciling invoices. Medical Coding is the most critical element, assigning specific functions a unique numerical identifier to keep track of. Verifying coverage and obtaining pre-authorizations are essential to ensure no charges go unpaid. Claims can take weeks – or even months – to receive payment from insurers, so monitoring them closely is necessary.

Reconciling invoices against costs when they arrive also helps maintain accuracy between amounts charged and those paid by the insurer. Health insurance claims processing creates accurate patient care records while ensuring providers receive adequate service reimbursement. Those interested in learning more about coding careers in this field can visit the American Academy of Professional Coders (AAPC) website for comprehensive resources on its processes.

The two most common types:

It is a complex and detailed process that can be overwhelming if you need to familiarize yourself with its different forms. There are two main types of it: active and passive. Active health insurance claims processing involves contact with the patient or their clinical care provider for each transaction. It is often used when an agreement between the patient and a specific medical health provider defines the services provided, such as an insurance policy or managed care plan.

medical billing VA writing on the desk with a pen and a paper

In this case, bills are sent to the patient based on their agreement with the medical health provider, including all applicable fees, co-pays, deductibles, etc. Passive health care invoicing is when transactions occur independently from interacting with the patient or their medical support provider. This method is less detailed and generally offers lower reimbursement rates than active billing as it does not track services rendered by a specific medical health provider. Passive health care reimbursement requires little to no paperwork and relies more on automated processes such as electronic invoice submission and verification systems.

Both types of healthcare invoicing have advantages and disadvantages, but it is essential to understand how each works to decide which form is best for your medical practice. Active health care reimbursement provides higher reimbursement rates. Still, it may require more paperwork to accurately track services rendered, while passive it tends to have lower reimbursement rates but can reduce errors due to its automated processes.

What are the basics of Health Care Revenue Cycle Management?

It’s crucial to make a lot of people aware of the basics of medical reimbursement and how it works. It is an essential process in health care that ensures patients receive a fair refund for services rendered. The process involves submitting a claim to insurance providers for payment on the patient’s behalf.

Medical bills contain various components, including the type of service provided, the date of service, the code assigned to the procedure, an itemized list of services rendered, provider information, and patient demographic information. In addition to these details, medical bills must include the patient’s policy number and any applicable discounts or adjustments as dictated by their insurance provider.

Accurate healthcare invoicing requires precise documentation from medical assistance providers. This includes ensuring no discrepancies between what was billed and what was done during each patient visit. If errors are found within the bill, it can result in overpayment or delayed reimbursement. It is also important to note that Medicare and other health plans require particular forms of clinical documentation, such as a Superbill, that contain detailed information about services provided.

Medical accounts receivable is a complex process that often changes due to new regulations by insurance companies or government entities regarding reimbursement claims submitted by various healthcare facilities and service providers. Accurate medical reimbursement must be managed daily to ensure quality patient care.

Are Medical Billers Better Than Coding?

Medical biller making claims for medical services is known as medical accounts receivable: claims to insurance providers on behalf of patients, while the medical coding system is used to classify services and procedures. They are essential to the healthcare industry, but neither replaces the other.


It is critical to ensure patients receive appropriate care reimbursement. Inaccurate bills can lead to overpayment or delays in payment, resulting in monetary losses for both parties. Therefore, service billing specialists must be knowledgeable about regulations and policies set forth by government entities and insurance companies.

Medical coding program is equally essential as other coding programs. It ensures codes are accurately assigned to each healthcare provider’s service and procedure. An error in coding can lead to incorrect payments or even a lack of coverage, depending on the patient’s policy terms. Therefore, a certified professional coder must comprehensively understand ICD-10 coding and all relevant federal billing and other coding guidelines and regulations.

Some may argue that medical accounts receivable are better than coding due to their more direct impact on patient reimbursement. Still, both processes are equally crucial in assuring quality care for all patients. With accurate bills and codes, insurance providers can reimburse healthcare providers for services rendered adequately and rightfully bill patients according to their coverage terms.

Sources:  Wikipedia

Healthcare Revenue Cycle Management: A Successful Future

Moving to a paperless environment, VMAs are becoming essential for medical billing and Coding tasks. Virtual assistants save time and money by creating claims, submitting insurance, processing patient data, and maintaining files. Transitioning constantly in healthcare, virtual coders will play an essential role in healthcare billing and Coding in the future.

Practice management process


Submitting and tracking insurance claims with insurers is a healthcare billing virtual assistant. Charging for medical services can be complex and lengthy, yet a virtual online medical billing assistant handling your revenue cycle management software can simplify it.

Medical coder degree program transforms diagnoses and procedures into universal diagnosis codes; this enables tracking patient payments and medical claims. Professional coders are exacting in verifying the accuracy of principles, but a virtual medical assistant ensures the same degree of Coding program precision, saving time and money during the medical Coding certification accounts receivable process. Here are the basic steps:

Patient information

Patient registration is handled by virtual medical assistants when they call for an appointment. Vital information must be gathered or verified for new/regular patients: name, birthdate, visit reason & insurance provider/policy number. Healthcare providers need to know the services covered by insurance; records are required for claim preparation & prior authorization billing cycles. Patient records must stay up-to-date and organized to justify the healthcare services provided/care performed. Patients are responsible for bills, including Medicaid services, co-pays, deductibles & other expenses. virtual medical administrative assistant ensures patients understand their responsibility, provides payment plan information & answers questions.

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Healthcare Providers and Financial Capability

medical billing virtual assistant holding a pen and a paper

Virtual medical billing and coding assistants can play a vital role in verifying a patient’s financial capability by reviewing insurance details and identifying covered procedures and services. This helps to reduce the possibility of rejected or denied claims. Explaining expenses not covered by insurance providers assist consumers in understanding their patient financial responsibility. Hence, they are aware of any costs they may incur and can avoid surprises in the future.

By utilizing virtual medical assistants to review insurance details proactively, patients can become empowered to make the best financial and mental health decisions, eliminating surprises and ensuring that their spending aligns with expected coverage.

Coding Program and Super Bill

Coding program: A medical coder translating medical information into alphanumeric codes is essential for submitting claims to insurance companies or third-party payers. A virtual medical billing and coding assistant aids in this process by transcribing reports, ensuring accuracy and that no critical details are overlooked.

Additionally, a superbill must be constructed containing medical health provider and patient information, including procedures and services rendered, diagnosis, and associated codes. This document is crucial for submitting insurance claims specialists; thus, its creation must be precise and clear. Computational assistance can aid in creating an accurate and understandable superbill.

Create insurance claims

Medical billers create claims that include info needed for insurance companies. Virtual medical assistants can ensure the accuracy and completeness of claims by transcribing medical reports into codes, helping to avoid missed information. They also review the claim to meet HIPAA standards and help secure service payments.

Submitting claims

Submitting claims electronically is critical for medical billing processes. VMAs have the required knowledge and experience to ensure accuracy and timeliness. They can track claim status, review accepted vs. rejected vs. denied claims, and make necessary corrections. All this comes with a time-consuming burden that can affect medical staff.

General Questions For You

Frequently Asked Questions

Medical billers are responsible for calculating and collecting payments for healthcare services such as procedures, tests, or surgeries. They collaborate with patients to create a payment plan that fits their budget and provide them with an invoice after each visit. This helps ensure that payments can be made promptly. Medical billing also answers patient questions about medical billing or services, reviews insurance plans and coverage limits, checks codes for accuracy and completeness of invoices, processes adjustments or refunds when appropriate, verifies insurance information, and keeps records of all billing-related activities.

The primary difference between medical billing and coding is that billers are responsible for facilitating payments from patients and insurance companies, while coders assign the correct codes to patient data. Medical coders use information from patient visits to determine which codes should be used in a claim. These codes are used by insurance providers to determine how much each procedure or service costs, how much the patient will owe, and how much the insurance company will cover. On the other hand, medical billers work with providers and payers to ensure the timely payment of claims. They also review invoices for accuracy, verify insurance information, answer patient questions regarding billing or services, process refunds or adjustments if necessary, and maintain records related to billing activities.

To be an effective medical biller, you need specific skills and qualities such as assertive communication and active listening, problem-solving, attention to detail, organization aptitude, time management, and multitasking abilities. In addition to these qualities, medical billers must also be able to work well in a team setting and understand health insurance policies or have experience with Coding. Additionally, computer proficiency is essential as medical billers often use software systems such as patient accounting systems and medical billing suites.

virtual assistant medical biller holding a cup of coffee

Following up on claims

Virtual assistants can help get the burden of finding medical billing off you and your staff by following up on denied claims and trying to get them approved. Medical claims may be rejected or denied by insurance companies for various reasons, such as:

1) Eligibility

A certified virtual assistant must recheck the provider ID number to verify eligibility and a viable claim. A virtual assistant ensures patient data accuracy before registration and scheduling to prevent rejections or denials. They can also obtain copies of health insurance cards and confirm correct data entry. Additionally, a VA can verify eligibility dates and acquire claim authorizations.

2) Invalid or incorrect Medicare ID number

Medical billing and coding virtual assistant would need to recheck your patient’s card to ensure that the number provided and the format are correct. They can also call out to verify this information with the client if necessary.

3) Diagnosis code error

To ensure valid diagnosis codes and maximum revenue, a virtual assistant can help verify codes specific to each procedure and confirm the diagnosis’s coding course is active for the DOS. A virtual scribe will also organize back-end medical billing and Coding, plus guarantee accurate entries are made without invalid diagnosis codes. This process safeguards consistency between diagnoses, online medical coding programs, and procedures while relieving your staff of busy work.

4) Invalid or incorrect National Provider Identifier (NPI)

A virtual assistant can ensure that your medical practice’s tax ID and provider information are current. A virtual assistant can also confirm the online medical billing provider is licensed with the payer or payers to avoid billing provider “missing or invalid” rejections. Ensuring enrolled healthcare professionals submit electronic claims and confirm that the correct group or individual NPI and tax ID is licensed reduces the possibility of rejected or denied claims.

Billing patients

Medical collections can be tedious. Keep track of procedures and costs, and generate the medical billing statement. Patients may have to pay a portion themselves. A medical billing and coding software or virtual medical billing and coding assistant can help–sending invoices and collecting payments quickly. Generate patient bill statements easily, containing a detailed list of procedures, costs, amounts paid by the insurance company, and due from the patient, all without worrying about details.

Other administrative tasks

va medical biller holding a phone

A virtual assistant assists with administrative duties for physician practices, like scheduling appointments, answering phones, etc. Moreover, they can help simplify joint billing, collections, and coding processes–which are time-consuming and complex–freeing up valuable time for medical practices.

Medical data entry is another task that a virtual assistant excels at; it entails accurately inputting disparate patient information into the correct fields within EHRs. By using medical data and software like EHRs, VMAs can perform these tasks remotely and quickly.

By utilizing the services or the website provider of billing software and coding virtual medical billing and coding assistant, medical practices can save time and money while taking advantage of their expertise in the coding field to ensure accurate and timely patient data entry. This will ensure that each patient’s medical records are up-to-date, secure, and available if needed.

Cost of Traditional Medical Biller vs. Online Medical Billing Assistant

Medical collection is vital in today’s healthcare landscape, and a skilled medical biller is essential. A traditional medical biller may cost between $25,000 to $50,000 per year, with benefits like health insurance, paid time off, and 401k contributions making them worth the investment. Medical coding training is also needed, translating medical terminology into procedure codes for easy understanding.

New technology has made virtual assistants an option, offering packages of up to several hours per week at rates from $25 to $50 per hour. They help practices save time and money by submitting claims, coding schools, maintaining patient files, and performing other administrative tasks. By outsourcing to a specialist, costs and efficiency can increase. Portiva offers industry-leading vetting for top-quality service.

Benefits of Hiring

There are many benefits of having Portiva’s virtual assistants. The following are just a few of them:

Reduced cost

Virtual assistants are a cost-effective alternative to traditional medical billers – saving medical practices an average of 50% on professional medical billing costs. With Portiva, healthcare professionals can find quality medical billing and coding services for as little as $10/hour – one-fifth of the price for a full-time employee.

Increased efficiency

Outsourcing code claims to process to Portiva’s virtual assistant allows practices to free up staff time and energy to focus on the important stuff. Submitting claims, keeping patient files up-to-date, and scheduling appointments? Virtual medical billing and coding assistants can do that! Plus, they take phone inquiries, too. All with improved efficiency!

Accurate: Medical Billing and Coding

medical billing virtual assistant holding a cup

Accurate medical billing and coding are essential for any successful business. It ensures timely payments to suppliers and customers, prevents costly errors, and maintains correct financial records. Accurate medical billing and coding keep companies on track financially and customer satisfaction through actual charges, invoices, and payment processing.

Moreover, accountants or consultants provide additional accuracy and help comply with laws. Furthermore, customers have confidence in their purchases when bills from reputable vendors are accurately itemized. Accurately, medical billing safeguards a business’ bottom line while providing excellent customer service.

Improved patient satisfaction

Outsourcing code claims processing to a virtual medical billing and coding assistant improves patient satisfaction with on-time payments and quick dispute resolution. Additionally, virtual medical billing and coding assistants enable better communication, informing patients of their bills.

Streamlined process

Virtual assistants swiftly collaborate with EMRs and medical software, facilitating an orderly medical billing process that guarantees timely, accurate claims submission.

Preventing physician burnout and medical staff attrition rates

Virtual assistants are also helpful for dental practices. Similar to their role in the medical collection, a virtual assistant can take care of necessary tasks such as submitting claims and managing patient records. They offer a cost-efficient and quick solution for practices looking to reduce physician burnout and improve staff retention. Portiva’s experienced virtual assistants are available 24/7 to help you with dental virtual assistant needs.

An Essential Component of the Health Care Industry

The healthcare industry is rapidly evolving as new technologies and innovations continue to shape the future of medicine. One crucial aspect of healthcare that many people overlook is medical billing and coding. Medical billing and coding are the backbones of the healthcare industry, ensuring that medical records are accurate and current. This article will explore the significance of medical billing and coding, its importance to healthcare industries, and the vital role that coding professionals play in the healthcare ecosystem.

Medical billing and coding involve using specific codes to accurately document and communicate medical information. Medical billing and coding professionals are responsible for translating medical terminology into standardized code classification systems that health insurance companies use to reimburse healthcare industries. This task requires a thorough understanding of medical terminology and coding certification to ensure accurate documentation meets legal and regulatory requirements.

Various coding programs and online courses are available for medical billing and coding professionals to gain coding certification. A certified professional coder (CPC) is a highly skilled professional with extensive medical coding and billing training. A coding certification is essential for ensuring accurate documentation, protecting patient privacy, preventing fraud, and complying with regulatory requirements.

The need for accurate medical records is at the heart of medical billing and coding. Medical records are essential for quality care and reimbursement by health insurance industries. Coding medical billing records requires attention to detail, as any document mistake can lead to incorrect billing and denial of refund.

Hiring Certified Professional Medical Coders: Ensuring Accurate & Effective Medical Coding

Hiring a certified professional coder can be beneficial for any healthcare organization. Medical coders are highly trained and must pass a strict coding certification to perform their duties accurately and effectively. Healthcare organizations must take the time to thoroughly evaluate potential candidates, as they need to ensure they have the proper knowledge, coding skills, and aptitude for medical Coding. During the hiring process, employers should inquire about the candidate’s credentials, experience with coding software, and industry knowledge. Employers should also establish clear expectations regarding job performance and responsibilities. Employers can successfully hire a certified professional coder who will impact patient care by ensuring all qualifications are met before bringing a new medical coder on board.


In summary, medical billing and Coding is a complicated process. It requires specialists to understand the various regulations and medical industry rules that must be adhered to and have the technical skills necessary to manage and operate the system for any medical records effectively. With Portiva’s comprehensive virtual medical billing and coding assistant services, you can trust that your organization’s accounting processes are accurate and up-to-date with best industry practices compared to other medical billing companies. Using their expertise, your office can maximize efficiency while minimizing costs to reach optimal performance levels. What is a virtual medical billing professional and assistant? Visit portiva.com today for more information on how we can help your practice!

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