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Why is the billing process important? Explain

By GinaUpdated 1 min read

The reimbursement cycle

Claim paid Refused — appeal it

STAGE 01Verifyeligibility, benefits, cooSTAGE 02Code encounterICD-10 diagnosis, CPT and STAGE 03Charge entrythe superbill becomes charSTAGE 04Submit claimCMS-1500, or the 837 electSTAGE 05Adjudicationthe payer decidesSTAGE 06Post paymentread the ERA or EOB and poSTAGE 07Patient balancestatement, then accounts r Refused → appeal
The seven stages of the medical billing reimbursement cycle, with denied claims looping back through appeal to resubmission.

by Debra Massenburg
(Fayetteville,NC, U.S)

Needing help with this question: Why is the billing process important?

Answer:
The medical billing process is important because it’s the means by which providers (and their employees) are paid for their services.

The process itself – submitting claims, posting payments, billing patients, following up on unpaid accounts – if not done correctly has many opportunities for a provider to miss reimbursement for their services.

Many practices underestimate the effort and time required to bill properly. Simple follow-up on unpaid claims can require hours on the phone to resolve.

Promptly and accurately understanding and entering insurance and patient payment, copays, deductibles, etc is essential.

Hope this helps and answers your question.

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