The Daily Billing Momentum

Medical Coding: The Translator

What it is: Medical billing and medical coding are two distinct but closely related functions that are absolutely essential to the financial health of any healthcare organization. While they often work hand-in-hand and are sometimes even performed by the same individual in smaller practices, understanding their individual roles is key to comprehending the healthcare revenue cycle.

Medical Billing: The Financial Manager

What it is: Medical billing is the process of submitting and following up on claims with insurance companies (and sometimes directly with patients) to receive payment for the medical services provided. It essentially translates the coded information into a financial claim.

In essence, medical coders build the accurate foundation of medical data using a universal language, and medical billers use that foundation to navigate the financial complexities of the healthcare system, ensuring providers get paid for their services. Both roles are vital and contribute significantly to the overall efficiency and…

Medicaid Members in a Molina plan will be switched to the new Humana Healthy Horizons of Virginia plan effective July 1, 2025.  

In the intricate landscape of healthcare, the financial health of any practice hinges significantly on its proficiency in medical billing and denial management. Far more than just submitting claims, mastering these areas requires a strategic, proactive, and detail-oriented approach. It encompasses a deep understanding of ever-evolving payer policies, meticulous coding accuracy, and a robust system for tracking, appealing, and preventing claim denials.

Effective medical billing is the bedrock of consistent revenue cycles. It demands a commitment to clean claim submissions, minimizing errors from the outset, and leveraging technology to streamline processes. However, even the most diligent billing efforts can be derailed by denials, representing a significant drain on resources and a direct threat to a practice's financial viability.

Therefore, true success lies in the ability to not only process claims efficiently but also to navigate the complexities of denial management expertly. This involves a comprehensive understanding of common denial reasons…