Credit Balances
Managing credit balances, where providers receive more money than billed, is critical. Identifying overpayments and promptly refunding them is essential
Denial Management
Denials or reimbursement issues should be addressed promptly. If a claim is denied, billers work to resolve the issue. This
Patient Payments
Once remittance advice is posted, patient statements are sent for outstanding balances. Timely patient statement delivery facilitates quicker payments. These
Payment Posting
Upon receiving electronic remittance advice (ERA) or explanation of benefits (EOB), payments must be posted. This includes zero-dollar remittances, which
Claim Tracking
After submission, billers must monitor claim statuses regularly. Clearinghouses often provide dashboards for easy access to claim status updates. Payers
Claim Submission
Provider organizations can submit claims directly to payers electronically or through clearinghouses. Clearinghouses review, edit, and format medical claims before
Claims Forms
Medical billers mainly use two claim forms for payment from insurers: the CMS-1500 for reporting professional services and the UB-04
Claim Scrubbing
Before submission, billers scrub claims to ensure the presence and accuracy of procedure, diagnosis, and modifier codes. Claim scrubbing also
