Medical Billing Process

A comprehensive approach to revenue cycle management

Insurance Eligibility Verification

We verify patient coverage before service to prevent claim denials and ensure accurate billing information.

Patient Demographics Entry

Accurate capture of patient information including demographics, insurance details, and authorization numbers.

3
ICD, CPT & HCPCS Coding

Our certified coders convert medical records to accurate alphanumeric codes ensuring proper reimbursement.

4
Charge Posting

Charges are posted according to payer-specific rules and fee schedules for maximum reimbursement.

5
Claims Submission

Electronic and paper billing with claim scrubbing to ensure clean claims and faster processing.

6
Payment Posting

ERA/EOB processing with accurate payment posting and variance identification.

7
A/R Follow-up & Denial Management

Proactive follow-up on outstanding claims, denial analysis, and appeal submissions.

8
Patient Statements

Patient billing, statement generation, and collections for patient responsibility balances.

9
Reporting & Analytics

Comprehensive reporting and insights to track performance and identify improvement opportunities.

10
Patient Scheduling

Full cycle completion with scheduling optimization for continued patient engagement.

Workflow Optimization

Balancing automation with human expertise

Human-Driven Tasks

Expert oversight where it matters most

  • Manual eligibility verification for complex cases
  • Human-driven coding quality assurance
  • Direct insurer A/R follow-ups
  • Appeal letter preparation and submission
  • Complex denial resolution
  • Provider communication and support

Automated Workflows

Technology-driven efficiency

  • RPA bots for claim status checks
  • API-based insurance verifications
  • ERA auto-posting
  • EMR-to-billing integration
  • Automated claim scrubbing
  • Real-time eligibility checks
Outcome: Increased operational efficiency with human oversight for quality assurance

Technology We Use

Industry-leading platforms and tools

Claim Tools
Kareo
PracticeSuite
AdvancedMD
CollaborateMD
Clearinghouses
Waystar
Change Healthcare
Office Ally
Availity
EMR/EHR Platforms
Epic
Cerner
Athenahealth
Allscripts
eClinicalWorks
NextGen
Reporting & Analytics
Tableau
Power BI
Google Data Studio

ICD-10 & Medical Coding

Accurate coding is the foundation of successful reimbursement

The International Classification of Diseases, 10th Revision (ICD-10) is a medical classification system used to code and classify diagnoses, symptoms, and procedures. Our certified coders translate clinical documentation into standardized codes that:

  • Ensure accurate claim submission
  • Maximize appropriate reimbursement
  • Maintain compliance with regulations
  • Support clinical documentation improvement
  • Enable accurate reporting and analytics
Example: Clinical to Code
Clinical Documentation:

"Patient presents with Type 2 diabetes mellitus with diabetic chronic kidney disease, stage 3"

ICD-10 Codes:

E11.22 - Type 2 diabetes mellitus with diabetic chronic kidney disease

N18.3 - Chronic kidney disease, stage 3

Ready to Optimize Your Revenue Cycle?

Let our experts streamline your billing process for maximum efficiency.

Schedule a Consultation