Medical billing is incredibly complex. There are a lot of factors involved when it comes to expertly crafting a medical bill. The slightest error can end a reimbursement or claim. A human mistake can end up in claim denial. Finding the best approach, the best practices, and the most efficient methodology is critical, as it allows practitioners to focus their entire attention on their business model — not only on scaling it up, and optimizing its framework but on their patients, on those they serve. A clear understanding of the medical billing process will help you concentrate more on the healthcare aspects of your practice. In this article, we’ll discuss what effective medical billing looks like, and, ultimately, how to improve the process.

What Is Medical Billing

Medical billing translates all healthcare services provided into a billing claim. The process is complex and in essence, it involves submitting claims to insurance companies, healthcare services, and other third parties for services rendered.

This process makes sure that the provider receives their due payment for services. Payments reflect services rendered and are normally canceled in a timely manner.

What about medical coding? Is it the same as Medical Billing?

Medical coding, another practice, is different from medical billing. The former has to do with the documentation of what you - as a practitioner - did to a patient during their diagnosis, their treatment, and their subsequent follow-ups.

In Medical Coding, the trained professional and their staff read over all the documentation that was generated during the patient’s time in their care. Then the staff generates a medical history of their patients. Each procedure, each diagnostic, each lab exam, absolutely everything done to the patient can be rendered into codes. For example, a broken arm has a code, the same as the diagnosis of a disease.

medical billing vs medical coding

This is later used during the process of billing. Why? Because those codes are universal. Every institution, company, and practitioner uses them.

Who normally takes care of the medical billing process?

The medical billing process is generally handled in-house, either directly by the practitioner or by their staff. This is how the process has worked for countless years.

Nevertheless, the digital age has brought about a change in practices. Nowadays, all healthcare services and insurance companies have migrated into digital platforms. It makes them more efficient as well as intuitive. Not only that, but it streamlines their model and makes them more secure. This revolution is ongoing and it’s only getting started. With the advent of blockchain technology, AI, and even the metaverse, more and more companies are going to lean heavily on the use of digital platforms and are going to expand these services — demanding, in some cases, for everyone to adopt them.

In becoming more efficient, the medical billing process is also becoming a bit more complex if you’re not tech-savvy, and third-party services are now being subcontracted for it.

These subcontractors have better technological tools and are more aware of regulations and updates to legislation concerning it. This includes staying abreast of privacy and security standards governing the underlying data (i.e. HIPAA).

The Process of Medical Billing

Every company and practitioner follows its own process. They have their own rules and steps that have worked for them when it comes to medical billing solutions and revenue management. Still, on average, the process stays close to the following steps:

Patient registration

Data about the patient is recollected. This includes insurance providers. A “folder” is started on a patient or added to an old one already in the practitioner’s care regarding that individual.

Insurance verification

The team verifies the patient’s healthcare coverage — end to end. During this step things concerning co-payment, benefits, services that can be rendered, eligibility responsibilities, policy clauses are examined and jotted down.

insurance verification in medical billing


The patient’s care and different encounters are registered and recorded by the practitioner.

Medical transcription

Files, recording, everything is transcribed and later formatted. Information is verified and wrong data, which might ultimately hurt the patient or the claim redacted.

Medical Coding

The transcribed information is translated into medical codes— this saves time.

Charge transmission

This part of the medical billing process steps is when the practitioner, their staff, or third-party billing specialists send claims to the adjudicating entity (such as Alberta Health). In the case of an AHCIP claim, it is transmitted through to H-LINK for assessment. During this stage, you might encounter errors such as:

  • Not filling out mandatory fields.
  • Invalid information that clashes with the patient’s records.
  • Missing information such as the referring physician.
  • A clash between what is an allowable Health Service Claim for the work performed (as determined by an ICD10 code).

Denial management

If a claim is denied, it could be for numerous reasons — depending on the reasons, there may be steps you can take in order to fix these issues and get paid.

Payment posting

Your payment is transferred directly to your business account.

medical billing payments

Medical Billing Software and Third Party Helpers

Medical billing agents, or claim submission software firms, specialize in optimizing the medical billing process. They reduce denials, safeguard financial records and patient data, use cutting-edge software, and employ billing specialists that are well versed in the thousands of claim types that exist.

The role of these companies is to ensure physicians are paid for services rendered, prioritize and argue denied claims based on reimbursement amounts, have quicker payment methods, and help out in every step of the billing process — doing much of the heavy lifting.

Often, outsourcing medical billing ensures that your practice not only stays profitable but is easier to handle. Professional service makes certain that your billing process is up-to-date, free of human errors, and technologically updated with different software and practices.

Expert teams in the field of medical billing have quality control measures in place, AI algorithms to help them out, and dozens of other tools that make the practice run smoother and more efficiently.

Medical billing software programs

Medical billing software, along with financial report software and other apps, are critical to the success of your practice.

These types of software can automate much of your medical billing requirements. Most are centralized platforms that manage all the steps listed above - from intake to reimbursement.

using medical billing software

They each have multiple features and cloud data processing power that allows them to centralize billing, process payments, host medical billings online, and automatically scrub your claims for errors, as well as translate records into medical coding.

How to Improve Your Medical Billing Process?

Using medical billing agents that use cutting-edge software is a surefire way to improve your medical billing process. Not only that, it future-proofs your company, by granting it adaptability power for the next wave of digital tools bound to change the medical billing infrastructure. Even less appreciated is the security that these providers can deploy to ensure all data is safeguarded and protected against breaches.

Software of this nature allows you to focus on your patients, on your passion, on why you became a doctor, while also making sure you’re turning a profit. It protects your revenue stream and safeguards it, automatically and easily. After all, isn’t it a hassle? All those steps? All those claims? All that paperwork?

Connect With Us

Want to learn more about our billing services and physician insights portal? We would be happy to connect with you!

About ResolvMD:

ResolvMD is an experienced full service medical billing company that empowers physicians to bill more efficiently through data-derived insights and democratized knowledge. We believe you should be as confident and competent in your billing as you are in your practice. Our proprietary Physician Insights Portal harnesses the power of data to deliver customized insights directly to you in real time. No more second guessing or feeling like you don’t have the transparency and accountability that you deserve. Paired with the most modern and secure platform on the market, you can rest easy knowing that we are taking care of all your billing needs while fine tuning your ability to understand best practices and earn what you deserve.