Medical coding is the process of translating healthcare diagnoses, procedures, services, and equipment into standardized codes. These codes (like ICD-10, CPT, and HCPCS) are used to bill insurance companies and patients for services provided by healthcare professionals. The coding ensures accurate billing, proper reimbursement, and compliance with regulations.

It is a review process that checks the accuracy of medical codes (such as CPT, ICD-10, and HCPCS) used in claims. The goal is to ensure that the codes correctly reflect the medical services provided and meet payer requirements, preventing billing errors, compliance issues, and potential revenue loss. This helps healthcare providers avoid overcoding, undercoding, or miscoding, which can lead to claim denials or legal penalties. Audits may be internal or conducted by third parties and focus on both compliance and revenue optimization.

Charge entry, or charge capture, refers to the process of entering and submitting the details of medical services provided to patients into the billing system. This includes selecting the correct CPT/HCPCS codes for procedures, ICD-10 codes for diagnoses, modifiers if needed, and patient information like date of service and place of service (POS). This data is then used to create claims, which are submitted to insurance companies for reimbursement. Accurate charge entry is crucial for timely and correct payment.

This is a review process to ensure that the charges billed to patients or insurance are accurate and compliant with regulations. It involves checking that the billed services match the documentation, verifying that the coding and charges are correct, and confirming that the billing practices align with payer policies and legal requirements. The goal is to prevent errors, reduce claim denials, and ensure proper reimbursement.

Claims filing involves submitting a detailed request for payment from insurance companies or government programs to cover the cost of healthcare services provided to patients. The process typically starts with the healthcare provider gathering necessary information from the patient, including their insurance details. Using this information, the provider creates a claim that includes patient demographics, diagnosis codes (ICD), procedure codes (CPT/HCPCS), and any relevant modifiers. This claim is then submitted electronically or on paper to the payer (insurance company or government program). The payer reviews the claim, processes it, and determines the amount they will reimburse. If there are any issues or denials, the provider may need to follow up, correct errors, or appeal the decision to ensure proper payment. Effective claims filing is crucial for timely reimbursement and managing revenue cycles in healthcare practices.

This process involves recording payments received from insurance companies or patients through electronic methods, such as ACH transfers or electronic funds transfers (EFTs). This process includes:

1. Receiving Payment: Electronic payments are deposited into the provider's bank account
2. Verification: Electronic payments are deposited into the provider's bank account
3. Posting: Electronic payments are deposited into the provider's bank account
4. Reconciliation: Electronic payments are deposited into the provider's bank account

This method streamlines the payment process, reduces manual errors, and speeds up the reconciliation of accounts.

This process involves the following steps:

1. Receive Payment: Electronic payments are deposited into the provider's bank account
2. Verify Payment: Electronic payments are deposited into the provider's bank account
3. Post Payment: Electronic payments are deposited into the provider's bank account
4. Adjust Balances: Electronic payments are deposited into the provider's bank account
5. Document: Electronic payments are deposited into the provider's bank account

This process ensures that payments are accurately reflected in the patient s account and that the billing records are up-to-date.

This process involves recording and managing claims that have been denied by insurance companies. This process includes:

1. Identifying Denials: Reviewing the Explanation of Benefits (EOB) to determine the reason for the denial.
2. Posting Denials: Entering the denied amount into the billing system and adjusting the accounts receivable records.
3. Resolving Issues: Working on correcting errors, resubmitting claims, or appealing denials to ensure the claim is processed and paid correctly.

Essentially, it's about managing denied claims efficiently to recover the owed amounts

The process includes reviewing denial reasons, correcting and resubmitting claims, appealing decisions when necessary, and ensuring compliance with payer policies to recover owed payments efficiently. This helps maintain cash flow and minimizes revenue loss for healthcare providers.

In U.S. medical billing, account receivables follow-up involves tracking and managing unpaid claims and patient balances. This includes:

1. Reviewing Aging Repots: Reviewing the Explanation of Benefits (EOB) to determine the reason for the denial.
2. Contacting Payers: Entering the denied amount into the billing system and adjusting the accounts receivable records.
3. Patient Communication: Working on correcting errors, resubmitting claims, or appealing denials to ensure the claim is processed and paid correctly.
4. Resolving Issues: Working on correcting errors, resubmitting claims, or appealing denials to ensure the claim is processed and paid correctly.
5. Documentation: Working on correcting errors, resubmitting claims, or appealing denials to ensure the claim is processed and paid correctly.

The goal is to ensure timely payment and minimize the time accounts remain unpaid.

This process involves examining insurance payments to ensure they match the agreed-upon rates in contracts or fee schedules. If an insurance company pays less than expected, the review process identifies discrepancies, corrects errors, and requests additional payment if needed. This ensures that healthcare providers are reimbursed appropriately for their services.

Credit balance review involves examining patient accounts to identify and resolve instances where the payer or patient has paid more than the amount due. This process ensures that excess payments are either refunded to the payer or applied to outstanding balances. It typically involves verifying payments against billed charges, adjusting accounts accordingly, and managing any necessary refunds or reapplications of funds.

This process involves examining payments received that exceed the billed amount. This process ensures that any excess payments are correctly identified, reconciled, and addressed either by refunding the payer, applying the amount to future bills, or adjusting the account balance. The review helps maintain accurate financial records and compliance with billing regulations.

This process involves examining and correcting discrepancies in claims and payments. This process includes:

1. Insurance Adjustments: Reviewing payments from insurance companies to ensure they match the billed amounts, correcting any underpayments or denials, and resubmitting claims if necessary.
2. Patient Adjustments: Verifying patient payments, including co-pays, deductibles, and any adjustments based on insurance coverage or billing errors, and ensuring patient accounts reflect accurate balances.

The goal is to ensure timely payment and minimize the time accounts remain unpaid.