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= Medical Billing Overview =
<h1>Medical Billing</h1>
Medical billing is a critical part of the healthcare workflow, ensuring providers receive accurate and timely reimbursement for services rendered. '''VEHRDICT''', in conjunction with WebShuttle, offers an integrated billing workflow that begins at the point of patient care and ends with payment posting.
<p>Medical billing is a crucial process in healthcare, ensuring that healthcare providers are reimbursed for their services. The following guide outlines the key steps involved in medical billing, from patient encounters to insurance verification and claims submission.</p>
<h2>Patient Encounters</h2>
From insurance verification to charge transmission and denial management, this guide outlines the full medical billing lifecycle.
<p>During a patient encounter, whether it's an office visit or a telemedicine call, the provider documents the details of the patient's condition and the services rendered in the EHR (Electronic Health Record) system. This includes:</p>
<ul>
<li><strong>Recording Condition and Services</strong>: Detailed documentation of the patient's condition and services provided.</li>
<li><strong>Transcription</strong>: Audio or video from the encounter is sent for transcription. Transcriptionists convert this into standard documents (e.g., History and Physical, Consultation, Operative Report).</li>
<li><strong>Documentation</strong>: Transcribed documents are attached to the patient chart in the EHR system, capturing the complete condition of the health record.</li>
</ul>
<h2>Insurance Verification</h2>
---
<p>Verifying patient insurance information is essential to ensure eligibility and policy benefits are documented. This step includes:</p>
<ul>
<li><strong>Eligibility Check</strong>: Confirming that the patient’s insurance is valid and active.</li>
<li><strong>Policy Benefits</strong>: Understanding the coverage details, co-pays, deductibles, and out-of-pocket expenses.</li>
<li><strong>Prior Authorization</strong>: Obtaining necessary authorizations from the insurance company for certain procedures or treatments.</li>
<p>Medical coding involves extracting codes from transcribed information to represent the patient's condition and services rendered. This process includes:</p>
<ul>
<li><strong>ICD-10 and CPT Codes</strong>: Using standardized codes to describe the patient's condition (DX) and services rendered (CPT).</li>
<li><strong>Coder Expertise</strong>: Experienced medical coders review and assign appropriate codes to ensure accuracy.</li>
</ul>
<h2>Entering Medical Charges</h2>
All billing begins with a documented patient encounter—either in-person or via telemedicine. Providers are responsible for recording:
<p>Charges for services rendered are entered into the patient invoice. This involves:</p>
<ul>
<li><strong>Assigning Values</strong>: Each service is assigned a specific charge based on standardized rates.</li>
<li><strong>Invoice Creation</strong>: The billing sheet is prepared, ensuring it is complete and error-free.</li>
</ul>
<h2>Charge Transmission</h2>
* '''Patient Condition (DX) and Services (CPT)'''
<p>Submitting claims to the insurance company is a critical step, known as charge transmission. This can be done electronically through EDI (Electronic Data Interchange). Key points include:</p>
* '''Transcription of Encounter Audio/Video'''
<ul>
* '''Final Documentation in EHR'''
<li><strong>EDI Submission</strong>: Secure and encrypted electronic submission of claims.</li>
<li><strong>Error Checking</strong>: Ensuring all mandatory fields are correctly filled to prevent claim rejections.</li>
Once transcribed, documents like H&P reports, consults, and operative notes are uploaded to the patient chart, forming the foundation for accurate billing and coding.
<p>Handling denied claims involves:</p>
<ul>
<li><strong>Follow-Up</strong>: Timely follow-up on denied claims to correct issues and increase the chances of payment.</li>
<li><strong>Evaluation</strong>: Understanding the reasons for denials and taking corrective actions to prevent future issues.</li>
<li><strong>Prioritization</strong>: Focusing on high-priority denials by payer and amount to maximize reimbursements.</li>
</ul>
<h2>Posting Payments</h2>
---
<p>Once payments are received, they need to be posted in the EHR system. This includes:</p>
<ul>
<li><strong>EOB and ERA</strong>: Processing Explanation of Benefits and Electronic Remittance Advice from insurance companies.</li>
<li><strong>Payment Posting</strong>: Applying the correct payment amounts to each invoice from bulk payments.</li>
</ul>
<h2>Example Screenshots</h2>
== Insurance Verification ==
<h3>Invoice List</h3>
Before billing, it is essential to confirm the patient’s insurance status and understand their benefits. This ensures coverage and reduces claim denials.
<p>The invoice list shows detailed information about each patient encounter, including encounter ID, date, patient name, code text, claim status, number of items, total charges, payments, and amount due.</p>
<h3>Apply Payment</h3>
* '''Eligibility Check''' – Confirm policy is active
* '''Policy Benefits''' – Review co-pays, deductibles, and coverage limits
<p>The apply payment screen allows administrators to enter payment details, including check/ref number, check date, deposit date, payment type, payer, and payment amount.</p>
* '''Prior Authorization''' – Secure approvals for procedures if required
<p>By following these steps, the medical billing process can be streamlined and efficient, ensuring accurate and timely reimbursements for healthcare services provided.</p>
<div style="text-align:center; margin: 1em 0;">
</body>
[[File:insurance_eligibility_nx.jpg|thumb|center|600px|'''Insurance Verification Screen''' – Review eligibility, coverage, and authorization status.]]
</html>
</div>
Information for each patient encounter is used for medical billing. The DX (condition of the patient) and CPT (service rendered to the patient) are used when generating proper medical codes for billing. ICD-10 and CPT codes can easily be extracted from the patient encounter and entered into an invoice used for medical billing. The coding information is used to generate HCFA 1500 (CMS 1500) forms for insurance submission or the information can be submitted electronically through EDI (Electronic Data Interchange) to a medical billing clearinghouse. WebShuttle will guide you through the medical billing process with tools and reminders that make it easy.
---
== Medical Coding ==
[[File:Medical billing 2.jpg|800px]]
Once documentation is complete, coders extract:
* '''ICD-10 Codes''' – Patient diagnoses (DX)
* '''CPT Codes''' – Services performed
==Insurance Verification==
Accurate coding is vital for correct billing and compliance with insurance regulations. Experienced coders ensure codes reflect the medical necessity and scope of service.
{{Tip|Coding errors are one of the top reasons for claim denials. Always double-check code pairings and modifier usage.}}
It is necessary to verify patient insurance information to ensure that eligibility and policy benefits are documented. This determines whether the insurance claim can be obtained for services rendered. Patient responsibilities such as co-pay, deductibles and out-of-pocket expenses need to be entered. With some services, prior authorization is required from the insurance company.
---
== Entering Medical Charges ==
[[File:Insurance screen.jpg|800px]]
Charges are entered into the system based on documented services:
* '''Assigning Charges''' – Each CPT code is linked to a standardized billing rate
* '''Invoice Creation''' – Review for completeness and accuracy before submission
==Patient Encounters==
This creates a billing record used for claim generation and submission.
---
When the provider encounters a patient during an office visit or telemedicine call, the details of the condition and service are documented in the EHR system. Audio or video are sent for transcription and all results are documented. The details can be recorded during the encounter or after the visit or call. Information about the medications and condition are all documented. Information from the encounter is used during coding.
== Charge Transmission ==
Sending claims to payers is done via secure EDI (Electronic Data Interchange):
* '''Error Checking''' – Automated checks to reduce rejections
'''VEHRDICT''' tools assist in preparing, reviewing, and transmitting claims efficiently.
Recorded audio or video is routed for medical transcription. The transcriptionist will convert audio to standard documents such as a History and Physical, Consultation, Operative Report, Letter, Discharge Summary or any custom document. Transcribed documents are automatically attached to the patient chart in the EHR system. The transcribed document contains the complete condition of the health record. Information from medical transcription will be used during coding.
{{Tip|Use the EDI error checker to catch missing diagnosis codes, date mismatches, or NPI errors before submission.}}
---
==Medical Coding==
== Denial Management ==
For denied claims, follow-up is essential:
Medical codes are extracted from the transcribed information. The patient's condition, medical services rendered, medical prescriptions are all converted into medical codes. The complete medical history is condensed into medical codes. Experienced medical coders are often involved in the medical coding process. Coders usually extract the DX (condition of the patient), CPT (service rendered to the patient) when generating proper medical codes for billing.
* '''Tracking and Follow-Up''' – Monitor status and resolve issues
* '''Root Cause Evaluation''' – Identify and address denial reasons
* '''Priority Handling''' – Focus efforts based on claim value and payer
{{Warning|Denials left unresolved can result in significant revenue loss. Implement a daily check of pending/denied claims.}}
==Entering Medical Charges==
---
== Payment Posting ==
Charges for services rendered will be entered into the patient invoice. Appropriate values are assigned to each of the services rendered. These charges will then be sent to the medical billing company (clearinghouse) or directly to the insurance company for a claim. The billing sheet must be complete and free of errors or it may reflect during a claim. Accuracy is very important during claim submission.
Once insurance payments are received:
* '''EOB & ERA Review''' – Cross-reference with expected charges
* '''Apply Payments''' – Match incoming payments with corresponding invoices
[[File:Medical billing 2.jpg|800px]]
Accurate posting ensures financial reporting and patient balance accuracy.
---
==Charge Transmission==
== Example Screenshots ==
Transmitting the claims to the insurance company is called Charge transmission. Electronic submission is called EDI (Electronic Data Interchange). EDI is secure and encrypted. Claims need to be without errors when transmitting through EDI. Errors can result in the following:
=== Invoice List ===
1. Mandatory fields need to be filled without errors. Claims with errors will be rejected.
<div style="text-align:center; margin: 1em 0;">
2. Invalid information in the patients health record will cause the claim to be rejected by the EDI.
[[File:Invoice_list.png|thumb|center|600px|'''Invoice List''' – View encounters, claim statuses, total charges, payments, and balance due.]]
3. Claims can be rejected due to insurance guidelines and payer details.
</div>
Denials need to be processed if a claim is rejected or not approved.
=== Apply Payment ===
<div style="text-align:center; margin: 1em 0;">
[[File:Apply_payment.png|thumb|center|600px|'''Apply Payment Screen''' – Enter and reconcile payment details from insurance payers.]]
</div>
==Calling about Denials==
---
== Summary ==
In many cases, it is necessary to to follow-up on denied claims to correct issues that prevented payment. Following up in a timely manner increases the chances of claims being paid. The goal is to receive payment for all services rending by the healthcare providers. Often, patient information is supplied and errors are rectified.
By following these steps in the '''VEHRDICT''' system, your practice can streamline billing workflows, minimize errors, and ensure fast and accurate reimbursements for all patient services.
==Denial Management==
Learning from prior denials and taking appropriate actions to correct issues is an important step in improving RCM (Revenue Cycle Management). Denial management is an important step in maximizing payment for services rendered. Determining the causes of denials will reduce the risk of future denials. A proper course of action should be takes after evaluating denied claims by the denial management team. Denied claims should be prioritized by payers and amounts to maximize reimbursements.
==Posting Payments==
Payments received will need to be posted into the EHR software. Correspondence, EOB (Explanation of benefits), and ERA (Electronic Remittance Advice) will received from the insurance companies. The proper amount will need to be posted to each invoice from bulk payment receivables.
[[File:Payment posting.jpg|800px]]
Latest revision as of 16:24, 20 June 2025
Medical Billing Overview
Medical billing is a critical part of the healthcare workflow, ensuring providers receive accurate and timely reimbursement for services rendered. VEHRDICT, in conjunction with WebShuttle, offers an integrated billing workflow that begins at the point of patient care and ends with payment posting.
From insurance verification to charge transmission and denial management, this guide outlines the full medical billing lifecycle.
---
Patient Encounters
All billing begins with a documented patient encounter—either in-person or via telemedicine. Providers are responsible for recording:
Patient Condition (DX) and Services (CPT)
Transcription of Encounter Audio/Video
Final Documentation in EHR
Once transcribed, documents like H&P reports, consults, and operative notes are uploaded to the patient chart, forming the foundation for accurate billing and coding.
---
Insurance Verification
Before billing, it is essential to confirm the patient’s insurance status and understand their benefits. This ensures coverage and reduces claim denials.
Eligibility Check – Confirm policy is active
Policy Benefits – Review co-pays, deductibles, and coverage limits
Prior Authorization – Secure approvals for procedures if required
Insurance Verification Screen – Review eligibility, coverage, and authorization status.
---
Medical Coding
Once documentation is complete, coders extract:
ICD-10 Codes – Patient diagnoses (DX)
CPT Codes – Services performed
Accurate coding is vital for correct billing and compliance with insurance regulations. Experienced coders ensure codes reflect the medical necessity and scope of service.
Tip: Coding errors are one of the top reasons for claim denials. Always double-check code pairings and modifier usage.
---
Entering Medical Charges
Charges are entered into the system based on documented services:
Assigning Charges – Each CPT code is linked to a standardized billing rate
Invoice Creation – Review for completeness and accuracy before submission
This creates a billing record used for claim generation and submission.
---
Charge Transmission
Sending claims to payers is done via secure EDI (Electronic Data Interchange):
EDI Submission – HIPAA-compliant, encrypted claim transmission
Error Checking – Automated checks to reduce rejections
VEHRDICT tools assist in preparing, reviewing, and transmitting claims efficiently.
Tip: Use the EDI error checker to catch missing diagnosis codes, date mismatches, or NPI errors before submission.
---
Denial Management
For denied claims, follow-up is essential:
Tracking and Follow-Up – Monitor status and resolve issues
Root Cause Evaluation – Identify and address denial reasons
Priority Handling – Focus efforts based on claim value and payer
Warning: Denials left unresolved can result in significant revenue loss. Implement a daily check of pending/denied claims.
---
Payment Posting
Once insurance payments are received:
EOB & ERA Review – Cross-reference with expected charges
Apply Payments – Match incoming payments with corresponding invoices
Accurate posting ensures financial reporting and patient balance accuracy.
---
Example Screenshots
Invoice List
Invoice List – View encounters, claim statuses, total charges, payments, and balance due.
Apply Payment
Apply Payment Screen – Enter and reconcile payment details from insurance payers.
---
Summary
By following these steps in the VEHRDICT system, your practice can streamline billing workflows, minimize errors, and ensure fast and accurate reimbursements for all patient services.
