Simplify Medical Claim Billing with Our Professional Service

Don't let medical billing claims stress you out. Our professional service simplifies the process and helps you get reimbursed faster.

Medical Claim Billing Service | Medical Billing Companies for Healthcare Claims Services

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Before you establish an in-house billing team or hire a medical billing service provider, you need to learn the basics. What is a medical claim, what is the medical claim service process, how do medical billing companies perform the task, and what are the benefits of outsourcing your billing process? Knowing about all this will help you make an informed decision and boost your revenue. Read further to get insights about the topic.

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Medical billing virtual assistants are becoming more popular among physicians' offices as they provide efficient support for managing operations and maximizing revenue.

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Prior authorization helps doctors avoid unexpected costs and patients avoid unnecessary expenses, ultimately resulting in cost savings for physicians and patients alike.

What is a Medical Claim?

 A medical billing claim is a bill that medical providers submit to a patient’s insurance company. This bill contains different medical codes detailing the treatment administered during the patient’s visit. The medical codes are used to describe services that the practice offers, including:

·         The procedure

·         Diagnosis

·         Medical devices

·         Medical supplies

·         Pharmaceuticals

·         Medical Transportation

When a healthcare provider submits a claim, it will include all important medical codes and the charges for all services. Payors or insurance companies check the medical codes to understand how they will reimburse the medical practices for their care. Furthermore, in a value-based care model, 30-day readmissions and length of stay impact practice reimbursements.

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Victoria Nutting D.O.

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Victoria Nutting D.O.

Board Certified Family Medicine Physician

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Mohammad Ashori, M.D.

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Mohammad Ashori, M.D.

Board Certified Family Medicine Physician

100 satisfaction
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What Type of Information Does a Medical Claim File Contain?

Each medical file includes specific details of every patient. In a medical claim file, these details are split into two parts:  the claim detail and the header.

Claim Header

It includes the summary of the most important information in the claim. The claim header usually refers to confidential patient information such as gender, date of birth, and zip code. Besides that, the claim header also contains information like:

·         Primary diagnosis code

·         NPI or National Provider Identifier for the service facility and attending physician

·         DRG or diagnosis-related group

·         Inpatient procedure

·         The overall charge for the claim

·         Name of the client’s insurance firm

Claim Detail

It includes detailed information about procedures or secondary diagnoses provided during an inpatient hospital stay. Every service record or new claim details includes the following information:

·         Procedure code

·         Date of service

·         NDC or National Drug Code

·         Procedure code

·         Corresponding  diagnosis code

·         The charge for the service

·         On-duty physician’s NPI number

What is the Claim Process in a Medical Billing Company?

Though you can create an in-house medical billing team, it will cost you exponential money and great stress. You need to practice ways to retain the best talent and regularly update your software. On top of that, you need to provide regular training to the staff to keep them updated with the changing laws. Running a medical billing team in your hospital or care is an added responsibility for the medical provider.

Hiring a medical billing team is critical. They provide you with top-notch services and make the medical billing process seamless. When hiring a billing team, you will have experts in the field on your side. 

The medical claims billing service provider will perform the accurate billing process to ensure the results. These steps decide the entire claim journey, from checking patients’ information to reimbursing money from patients. Here we have discussed every step in detail to help you understand how billing provider works.

Patient Registration

This is the first step of the medical claim in a billing service. Patient information is registered when patients give their personal and insurance details to clinics, hospitals, and other practices. It’s important to collect and store this data accurately to fill claims accurately.

Insurance Verification

Once the patient is registered, the billers need to verify the patient’s insurance. This step determines whether the patient has adequate coverage for treatment and care without paying it from pocket. Insurance eligibility validation is also critical to check if the patient is eligible for the treatment. Besides that, it will allow billers to get the answers to the following questions:

·         Do the insurance agency of the patient need pre-authorization?

·         Has your patient accumulated out-of-pocket expenses, co-pays, or deductibles?

·         What type of benefits does patient policy offer?

Entry of Charges

The best medical billing services add the charges they should get at the end of the care of patients. Providing the right amount of money for every service is important to prevent loss.

Medical Coding

This is an important but complex step that requires great training and understanding of coding to avoid making mistakes. The billers will do it once the patient gets the medical service. Medical coders will transcribe healthcare-related documentation like doctor’s notes and lab results into specific medical codes.

Converting medical information into codes is crucial because hospitals provide different services to patients with different diagnoses, drugs, lab tests, and other things. It’s challenging for the experts to understand a bundle of information. Therefore, billers use unique codes to describe which procedures, diagnoses, and prescriptions the medical staff has administered to streamline the process.

Moreover, they use different types of these systems based on the type of medical practice and services they provide. Here are some of the most common coding systems:

·         National drug code or NDC

·         Healthcare common procedure coding system or HCPCS

·         Current procedural terminology or CPT

·         Diagnosis-related group or DRG

Transmitting Claims to Payors

Claim transmission is performed to transfer a claim from the practice to the payor or insurance provider. In general, billing claims are first sent to the clearinghouse. They review the claims and reformat them if necessary before sending them to an insurance agency. But the best medical billing service can also send them directly to the insurance company. This reduces the time each claim takes to receive reimbursement.


Adjudication is when the insurance company receives your claim. The company will review the claim and check whether it meets its policy. They will also check the patient’s eligibility to get coverage. Once the insurance provider checks the claim’s authenticity, they will evaluate the claim amount they can reimburse.

If your claim gets accepted, the insurance company will reimburse and charge your patient for any remaining amount. However, the insurance coverage provider has the right to deny the claim if the patient is not eligible for the coverage, has insufficient coverage, or has not applied for pre-authorization for the medical treatment or care.

Whatever the reason for the denial, the medical billing provider can assess the claim, improve it, and then submit it again for approval. Your patient can also submit the appeal to get medical coverage to avoid paying for the services from their pocket.

The experienced medical team can easily identify the reason for the denied claims. The team of experts looks for errors in medical coding, formatting issues, inaccurate information, and other things to ensure they get approval on the second attempt.

However, when you hire leading experts in the industry, more than 99 percent of your claims will get accepted. Hence, less risk of denied claims, meaning less risk of not getting paid on time.

Create Bill Statement

Once the claim gets approval, the billing team will create the patient statement, which is the final step. This bill will include information on any remaining amount of services patients need to pay. The bill amount varies based on the care they get and their days at the medical care facility.

Reasons to Hire Revenue Cycle Management Company

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Medical claims billing service providers offer billing services that are otherwise challenging. They have the responsibility to improve the cash flow of your business while you can put your energy and time into improving your services. Some more advantages of employing a billing company are:

·         Fast and efficient workflow of healthcare practice without overburdening the medical team

·         No risk of confusion in dealing with different insurance companies’ payment policies

·         Few claim processing mistakes and submission errors

·         Claims are submitted at a rapid rate

·         A proper review process is done to ensure practices are reimbursed the full amount

·         Rejected or denied claims are resubmitted

·         Patient satisfaction rate  increases when claims are processed quickly and timely

·         The stress level and workload of the patients are reduced.

General Questions For You

Frequently Asked Questions

A medical billing service is a type of healthcare service that specializes in submitting and processing medical claims for payment. It is provided by a medical billing company or service company, and its primary goal is to help healthcare providers receive timely and accurate reimbursement for their services. Medical billing services compare pricing, web hosting, and features. They have billing staff that manages the entire revenue cycle of practice, and the services cover a wide range of medical services and healthcare claims. By partnering with healthcare services provider like Portiva, healthcare providers can focus on improving the quality of patient care while the billing experts handle payment and reimbursement processes.

In a medical office, billing refers to collecting payments for health care services. Medical billing encompasses a broad range of services, including processing insurance claims, payment collection from patients, compliance with regulations, and staff credentialing. Every aspect of medical billing needs to be reviewed for accuracy and efficiency, from urgent care to surgery. Service companies have emerged over the years, offering specialized billing services and leveraging technology such as EHR to improve the billing process and streamline staff workload.

The process of RCM, also known as revenue cycle management, involves a set of practices to optimise the revenue of a health service medical billing. This includes verifying eligibility, completing forms, and engaging in select performance metrics to show high-quality service. From engaging blogs to efficient practices, an effective RCM strategy can boost revenue and ensure the financial success of medical practice.

Medical billing is crucial because it helps healthcare providers manage their revenue effectively. With efficient billing practices and software, providers can ensure timely submission and accurate coding, which leads to quick payment from insurance companies. Moreover, credentialing is a vital aspect of the process as it helps the providers get recognized by insurance companies, broadening their market reach. In short, adopting the best medical billing practices is essential for running a profitable healthcare business and offering quality care to patients. Want to learn more? Check out our blog for informative posts on the topic.

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Medical Billing Services and Bottom Line

In a nutshell, billing service is a way to improve the cash flow of your business. Without the proper billing process, not only it’s challenging to expand your practice and difficult to sustain in the industry without the proper billing process. This is because you have to experience loss regularly, making it impossible for you to pay your employees, get equipment, or pay for other medical care expenses. 

So, you need medical claims billing service as well as a billing service provider who can make billing a seamless and stress-free process for you. In this case, contact or book an appointment at Portiva. By hiring us, you will be able to see significant changes in your financial condition in a few months. Contact us today!

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