Understanding Medical Billing Services.pptx

Understanding Medical Billing Services
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Efficient medical billing is essential to the financial success of every healthcare practice. From verifying
insurance coverage to managing denials and reconciling payments, each step in the revenue cycle must be
handled with accuracy, speed, and compliance in mind.
Medical Billers and Coders (MBC) provides comprehensive, full-service medical billing to alleviate
administrative burdens, enhance collections, and stay compliant with evolving regulations.
As a leading Medical billing and coding services company, we support healthcare providers in
maximizing efficiency through the synergy of cutting-edge Artificial Intelligence (AI) and deep Human
Intelligence (HI)—the intelligence of certified coders and revenue cycle professionals. Provides
comprehensive, full-service medical billing to alleviate administrative burdens, enhance collections, and stay
compliant with evolving.
Overview of Medical Billing Services:
Medical billing services involve taking clinical encounters and converting them into billable claims,
submitting them to payers, following up on denials, and processing payments. It involves:
● Insurance verification
● CPT, ICD-10, and HCPCS coding
●
Submission of claims
● Payment posting and reconciliation

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● Denial management
● Patient billing and collections
● Credentialing Services
● Reporting and analytics
Accurate billing ensures providers are paid on time and in full for their care. At MBC, we offer seamless, end-
to-end revenue cycle management integrated into your systems and processes so you can focus on clinical
outcomes while we handle your reimbursements.
Why Outsource Medical Billing?
Medical billing outsourcing is an effective strategy for practices looking for higher efficiency and financial
clarity. Providers can outsource the process to industry specialists who will perform it efficiently rather than
dealing with complicated coding regulations, payer rules, and staff issues internally.
Key Benefits of Outsourcing:
● Lower Operational Costs: Avoid the cost of hiring, training, and maintaining billing personnel in-house.
●
Faster Payments: Professional staff guarantee clean claim submissions and more rapid rejection
resolution.

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● Certified Billing Experts: Get access to CPC -, CPB-, and CCS-certified billers trained in payer-specific
guidelines
● Regulatory Compliance: MBC ensures that your billing practices are HIPAA, CMS, and state-specific
compliant.
● Scalability: Services expand with your practice without increasing internal resources.
Outsourcing to MBC gives you a cost-effective alternative to in-house billing and strategic insights to grow
your revenue.
Key Features of a Top Medical Billing Company
Not every medical billing agency offers the same level of service. At MBC, we provide a transparent,
technology-based experience supported by certified experts.
Features You Can Expect from MBC:
● 98%+ Clean Claim Submission Rate
Claims are audited by AI-based tools and human audits for precision.
● Dedicated Account Management
One point of contact guarantees efficient communication and prompt resolution of concerns.

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● HIPAA-compliant infrastructure
Patient data is encrypted, transmitted securely, and accessed over role-based access controls.
● Customizable Billing Packages
We customize our services to your specialty, EHR system, and specific workflow requirements.
● Real-Time Reporting
Monitor critical performance indicators (KPIs), collections, accounts receivable (AR) aging, and denial trends
using cloud-based dashboards.
Comprehensive Billing Services Offered by MBC
MBC offers a full spectrum of medical billing services to account for your revenue cycle needs. All services
are completed by certified professionals and augmented by innovative technology to maximize
performance.
● Insurance Eligibility Verification
We verify insurance status, coverage levels, and pre-authorization needs before each visit, lowering
eligibility-denied rates.

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● Medical Coding
Our AAPC- and AHIMA-certified coders apply CPT, ICD-10, and HCPCS codes from clinical documentation and
payer guidelines. We ensure modifier integrity and coding compliance.
● Charge Entry & Claims Submission
Data is entered correctly, and claims are submitted through clearinghouses or directly to payers, leading to
rapid processing.
● Payment Posting
We post and reconcile insurance payments, co-pays, deductibles, and adjustments to monitor finances
accurately.
● Denial Management
Our employees flag trends in denied claims, resolve errors, and pursue payers for appeal or reprocessing—
reducing your AR days and improving cash flow.
● Patient Billing & Collections
Clear, timely statements and online payment options help to improve patient collections. We also provide
soft follow-up support and flexible payment plan coordination.

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How AI and HI Work Together in Medical Billing?
Medical billing is increasingly becoming a technology-enhanced field where AI (Artificial Intelligence) and
HI (Human Intelligence) complement each other. MBC leverages both to optimize performance and
decision-making across the billing cycle.
How We Use AI (Artificial Intelligence)?
● AI-Powered Claim Scrubbing: Our system scans claims before submission for coding errors, missing
data, and documentation issues.
● Predictive Denial Analysis: AI analyzes historical trends to flag high-risk claims and recommend pre-
emptive corrections.
● Automated Payment Posting: RPA (Robotic Process Automation) tools automatically post payments
from ERAs, reducing manual workload.
● Real-Time Reporting Dashboards: AI-backed dashboards help providers dynamically track performance
and financial metrics.
The Role of HI (Human Intelligence):
● Clinical Judgment Coding: Certified coders apply Proper codes with contextual knowledge to
complicated documentation.

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● Appeal and Denial Resolution: Experienced billing specialists create effective appeals and communicate
with payers.
● Audit and Compliance Oversight: Human review ensures ethical programming, CMS compliance, and
HIPAA safeguarding of information.
● Client Relationship Management: Experienced account managers know provider goals and adapt
methodologies accordingly.
Why the Combination Works?
AI provides speed and automation, while HI guarantees precision, judgment, and compassion—particularly
where critical thinking and payer-specific expertise are required. For MBC, this AI-HI combination enables us
to enhance efficiency without sacrificing the integrity and personal touch that healthcare billing requires.
Specialties We Serve:
Billing must be tailored to every specialty's codes, payer regulations, and clinical workflows. At MBC, we pair
billing professionals trained in your specialty, allowing for more precise claims and increased approval rates.
We Offer Specialty Billing for:

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1. Family Practice
Family medicine encompasses a broad range of care—preventive visits, chronic disease management, acute
illness treatment, immunizations, and telehealth. With high volumes of patients and constant service
variation, billing needs to be stable and flexible
2. Dermatology
Dermatology billing has a combination of medical and cosmetic procedures. Every procedure—such as
excisions, cryosurgery, or phototherapy—needs proper coding with modifiers to differentiate between
diagnostic and elective care
3. OB/GYN
Obstetrics and gynaecology encompass extensive services like prenatal care, childbirth, treatment of
infertility, and gynaecologic surgeries. OB billing tends to need bundling numerous visits into a global
package and reporting services for months.
4. Optometry
Optometry billing demands attention to detail in separating routine vision care (usually billed to vision
plans) from medical eye conditions (billed to health insurance). Coding must clearly state the purpose of the
visit.

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5. Orthopaedics
Orthopedic billing includes fracture treatment, surgery, durable medical equipment such as braces and
splints, and follow-up visits. Bundled payments and global periods create issues that must be managed to
avoid lost revenue.
6. Wound Care
Wound care clinicians treat chronic ulcers, burns, surgical wounds, and pressure injuries. Billing needs to
account for wound size, depth, and treatment technique (e.g., debridement type or grafts), necessitating
thorough documentation
7. General Surgery
General surgeons perform a wide array of operations that may involve coordination with anesthesia and
post-op management. Surgery packages must be coded to include pre-op and post-op services.
8. Cardiology
Cardiology billing is complicated due to the many different diagnostic tests and interventional procedures.
All services need documentation that supports their level of complexity and medical necessity.

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9. Radiology
Radiology billing covers both the technical component (imaging) and the professional component
(interpretation). Both services have to be coded accurately depending on modality, the use of contrast, and
whether they're an add-on in a bigger bundle of services.
10. Mental Health & Psychiatry
Mental health practitioners must adhere to rigorous time-based billing, telehealth compliance, and
behavioral health codes. Such services also tend to have various payer rules for therapy, medication
management, and groups.
11. Home Health
Home health agencies have particular requirements regarding documentation and billing, particularly when
treating Medicare patients. Correct OASIS integration and adherence to CMS visit billing guidelines must be
followed.
Compliance and Data Security
Each step in the billing process at MBC is regulated through strict compliance processes to protect patient
data privacy and expose it to minimal audit risk.

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Key Compliance Features:
1. HIPAA-Compliant Operations
We train all our staff in HIPAA and perform regular updates. We audit work processes to ensure data privacy
policy compliance in all departments.
2. End-to-End Encryption
We protect data by storing it using AES-256 encryption and encrypting it when it is sent via SSL/TLS
encryption.
3. Role-Based Access Controls
Access to PHI is restricted by job function, and all is tracked and monitored for compliance.
4. Regular Audits and Quality Assurance
Our QA staff conducts ongoing internal audits for billing accuracy, coding compliance, and documentation
criteria.
5. Audit Support

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We support RAC audits, payer audits, and Medicare probes by preparing reports and handling responses
effectively.
How to Choose the Right Medical Billing Partner?
Choosing a medical billing partner is a decision that impacts your revenue, compliance, and patient
experience. Consider the following:
Evaluation Checklist:
1. Successful experience in your specialty
2. Transparent pricing with no surprise fees
3. Certified, experienced billing and coding professionals
4. Access to real-time analytics and reporting
5. Compliance-focused workflows
6. Scalable services that expand with your practice
7. Account manager and support team dedicated to you

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Medical Billers and Coders check all these boxes and go beyond transactional billing to be your strategic
partner.
Conclusion:
Your revenue cycle should be as professional as your clinical care. By combining the power of AI-driven tools
and human intelligence, Medical Billers and Coders deliver a more innovative, more accurate, and scalable
billing solution.
We specialize in delivering end-to-end medical billing services tailored to your specialty, built on a
foundation of technology, compliance, and personalized support. Whether you want to reduce denials,
increase collections, or simplify operations, MBC is ready to support your goals.
Ready to streamline your billing and boost your revenue?
Contact Medical Billers and Coders today for a free consultation and discover how our AI-enhanced billing
solutions can transform your revenue cycle.

Understanding Medical Billing Services.pptx

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