Definition
Medical Billing
Medical billing is the process of turning patient visits into insurance claims, submitting them to payers, and following up on payments, denials and patient balances so a practice gets paid.
In the US, medical billing typically covers patient eligibility checks, charge entry, coding with ICD-10-CM and CPT codes, claim submission to insurers, payment posting, denial management, accounts receivable follow-up and patient statements.
Small errors can delay or block payment, so practices track metrics like clean claim rate, denial rate and days in accounts receivable. Many outsource billing to specialists to collect more of what they're owed.
Medical billing in practice
A physiotherapy practice notices many claims are denied for missing authorisations. Its billing team adds an authorisation check before each first visit, resubmits the denied claims with the right documents, and reduces the time it takes to get paid.
Related terms
Common questions about medical billing
What is the difference between medical billing and medical coding?
Coding translates diagnoses and procedures into standard codes. Billing uses those codes to create claims, submit them and follow up on payment.
Why do insurance claims get denied?
Common reasons include eligibility issues, missing authorisations, coding errors, duplicate claims and missed filing deadlines.
Can medical billing be outsourced?
Yes. Many practices outsource billing to specialist teams, who must handle patient data in line with HIPAA in the US.
What is days in A/R?
Days in accounts receivable measures how long, on average, it takes a practice to collect payment after providing a service.
