Medical Billing: Your Healthcare Solutions

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Medical Billing: What does it mean?

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." ⭐⭐⭐⭐⭐


remote medical scribeMedical billing is a necessary process used in the healthcare industry. It consists of coding, submitting claims, verifying coverage and payments, and reconciling invoices. Coding is the most critical element, assigning specific procedures 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 reimbursement for services performed. Those interested in learning more about this field can visit the American Academy of Professional Coders (AAPC) website for comprehensive resources on it processes.

What are the two most common types of medical billing?

It is a complex and detailed process that can be overwhelming if you’re unfamiliar 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 healthcare provider for each transaction. It is often used when there is an agreement between the patient and a specific healthcare provider that defines the services being provided, such as for an insurance policy or managed care plan.

virtual scribeIn this case, bills are sent to the patient based on their agreement with the healthcare 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 healthcare 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 healthcare 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 health care invoicing have advantages and disadvantages, but it is essential to understand how each works so you can decide which form is best for your healthcare practice. Active health care reimbursement provides higher reimbursement rates but 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 Healthcare 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 healthcare that ensures patients receive proper reimbursement 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 health care invoicing requires precise documentation from healthcare providers. This includes ensuring there are 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 specific other health plans require particular forms, 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 healthcare providers. Accurate medical reimbursement must be meticulously managed daily to ensure quality care for all patients.

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

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

Medical coding is equally essential as it ensures codes are accurately assigned to each service and procedure a healthcare provider provides. An error in coding can lead to incorrect payments or even a lack of coverage, depending on the patient’s policy terms. Therefore, coders must have a comprehensive understanding of ICD-10 coding and all relevant federal billing and coding regulations.

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

Sources: Wikipedia

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Healthcare Revenue Cycle Management: A Successful Future

Moving to a paperless environment, VMAs are becoming key for health care billing and coding tasks. Virtual assistants save time and money with creating claims, insurance submissions, patient file upkeep, and more. Transitioning constantly in healthcare, virtual coders will play an important role in health care billing and coding’s future.

Medical Billing and coding process

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

Medical coding transforms diagnoses and procedures performed 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 precision, saving time and money during the medical 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 medical services/care performed. Patients are responsible for bills, including Medicaid services, co-pays, deductibles & other expenses. A virtual medical administrative assistant ensures patients understand their responsibility, provide payment plan information & answer questions.

Financial capability

what is medical billing and coding

Virtual medical 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, so they are aware of any costs they may incur and can avoid surprises in the future.

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

Coding and superbill

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

Additionally, a superbill must be constructed containing healthcare provider and patient information, including procedures and services rendered, diagnosis and associated codes. This document is crucial for submitting claims; 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. All sentences are less than 20 words.

Submitting claims

Submitting claims electronically is critical for 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 corrections if needed. All this comes with a time-consuming burden that can affect medical staff.

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Medical Billing: What You Need to Know

General Questions For You

Frequently Asked Questions

Medical billers are responsible for calculating and collecting payments for medical 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 billers also answer patient questions about billing or services, review insurance plans and coverage limits, check codes for accuracy and completeness of invoices, process adjustments or refunds when appropriate, verify insurance information, and keep 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.

The medical billing process consists of 10 steps:

  1. Patient Registration
  2. Verifying patient insurance and fiscal responsibility
  3. Patient-provider encounter
  4. Medical transcription
  5. Medical coding
  6. Charge entry/claim generation
  7. Claim scrubbing and transmission
  8. Claims adjudication
  9. Producing patient statements
  10. Statement follow-up and payment

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 billing suites.

There are three main types of medical billing systems: closed, open and isolated. Closed systems are those in which the patient information is stored in a system that is only visible to the healthcare provider. Open systems allow providers to share patient information with third-party payers and other entities like labs or specialists. Isolated systems are for medical facilities that do not interact with third-party payers or other entities and only use one specific software application for their billing process.

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Medical and Dental Virtual Assistants female nurse attending a patient
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Following up on claims

VMAs can help get the burden 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 VMA must recheck the provider ID number to verify eligibility and a viable claim. VMAs ensure 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, VMAs can verify eligibility dates and acquire authorizations for claims.

2) Invalid or incorrect Medicare ID number

A VMA would need to recheck your patient’s card to ensure that the number provided and the format is 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, virtual medical assistants can help verify codes specific to each procedure and make sure the diagnosis is active for the DOS. A virtual scribe will also organize back-end billing and coding, plus guarantee accurate entries are made without invalid diagnosis codes. This process safeguards consistency between diagnoses and procedures while relieving your staff of busy work.

4) Invalid or incorrect National Provider Identifier (NPI)

VMAs can ensure that your healthcare practice’s tax ID and provider information is up to date. VMAs can also confirm the billing provider is licensed with the payer or payers to avoid billing provider “missing or invalid” rejections. Ensuring that they are enrolled to submit electronic claims and confirming 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 billing statement. Patients may have to pay a portion themselves. A virtual medical assistant can help–sending invoices and collecting payments quickly. Generate patient bill statements easily, containing a detailed list of procedures, costs, amounts paid by insurance, and due from the patient. All without worrying about details.

Other administrative tasks

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VMAs can assist with administrative duties like scheduling appointments, answering phones, etc. Moreover, they can help simplify medical collections and coding processes–which are time-consuming and complex–freeing up valuable time for medical practices.

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

By utilizing the services of a VMA, medical practices can save time and money while also taking advantage of their expertise to ensure accurate and timely patient data entry. This will ensure that each patient’s records are up-to-date, secure, and available if needed.

Cost of traditional medical billers vs. virtual medical assistants

Medical collection is important in today’s healthcare landscape, and a skilled 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 coders are also needed, translating terminology into procedure codes for easy understanding.

New technology has made virtual medical 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, maintaining patient files and 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 Portiva

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

Reduced cost

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

Increased efficiency

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

Accurate billing

medical billing and coder

Accurate billing is essential for any successful business. It ensures timely payments to suppliers and customers, prevents costly errors and maintains correct financial records. Accurate billing keeps businesses on track financially and provides 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 billing safeguards a business’ bottom line while providing excellent service to customers.

Improved patient satisfaction

Outsourcing code claims processing to a VMA improves patient satisfaction with on-time payments and quick dispute resolution. Additionally, VMAs enable better communication, keeping patients informed of their bills.

Streamlined process

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

Preventing physician burnout and medical staff attrition rates

Virtual medical assistants (VMAs) are also helpful for dental practices. Similar to their role in medical collection, a dental 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 VMAs are available 24/7 to help you with any dental virtual assistant needs.

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

Portiva also caters medical coding and virtual administrative medical assistants.

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