Medical Billing & Revenue Cycle Management
Frequently Asked Questions
Your trusted resource for understanding billing processes, claims, compliance, and how MCB supports your practice.
Everything you need to know about medical billing, revenue cycle management, and how MCB supports your practice.
What is the medical billing process?
Medical billing is the process of translating healthcare services into standardized codes, submitting claims to insurance companies, and following up to receive payment for those services.
What are the basic steps in medical billing?
The process includes patient registration, insurance verification, charge entry, coding, claim submission, payment posting, and denial management.
Is medical billing easy to learn?
It depends on your background. While basic concepts can be learned quickly, mastering compliance, coding, and payer-specific rules requires formal training and experience.
Why is medical billing important in healthcare?
It ensures that healthcare providers get paid accurately and promptly for the services they deliver, keeping practices financially healthy.
What is the difference between medical billing and coding?
Coding involves converting procedures and diagnoses into standardized codes. Billing is the process of submitting these coded services to insurers and securing payment.
How long does it take to get paid after a claim is submitted?
Typically, 15 to 45 days depending on the payer. With MCB’s expertise, we aim to minimize delays and denials.
What is a clean claim in medical billing?
A clean claim is one submitted without errors, complete with all necessary information, and likely to be processed without delays.
Can patients see the billing codes on their statements?
Yes. Patients typically receive an Explanation of Benefits (EOB) with CPT/ICD codes for the services rendered.
What is a denied medical claim?
A claim that is rejected by an insurance payer due to errors, missing information, or coverage issues.
How can MCB help my practice with billing?
MCB provides end-to-end billing services, from coding and claim submission to denial management and reporting, boosting cash flow and compliance.
For General Public & New Clients
Faq: Medical Billing Basics
Understand the core steps, terms, and value of billing for new patients and first-time clients.
For Medical Admins & Office Staff
Faq: Insurance & Claims Management
Learn how claims work, common denial reasons, and how to manage insurance billing effectively.
What is a claim in medical billing?
A claim is a formal request for payment submitted to an insurance company for services provided to a patient.
What is claim adjudication?
It’s the insurance company’s process of reviewing and deciding on a submitted claim, resulting in approval, partial payment, or denial.
What does ‘claim not on file’ mean?
It means the insurer has no record of receiving the claim. This could result from submission errors or transmission issues.
What is a medical billing adjustment reason code?
These are standardized codes explaining why a claim was adjusted or denied (e.g., patient not covered, duplicate claim).
What are CPT codes in billing?
Current Procedural Terminology (CPT) codes represent the medical procedures and services performed.
What is the 80/20 rule in medical billing?
80% of revenue often comes from 20% of payers. Focused attention on top payers can significantly improve cash flow.
What are common reasons for medical claim denials?
Top reasons include incorrect patient data, non-covered services, lack of prior authorization, and coding errors.
What’s a contested claim?
A claim that’s been disputed by the payer, often requiring supporting documentation or resubmission.
What’s the difference between primary and secondary claims?
Primary claims are submitted to the main insurer. Secondary claims go to another insurer after the primary has paid.
How can MCB reduce denied claims?
Through precise coding, eligibility checks, and experienced denial management, we proactively reduce rejections.
Simplify Your Billing. Maximize Your Revenue.
Streamlined services tailored to your specialty.
- End-to-end revenue cycle management
- Fast claims processing and denial reduction
- EHR integration with real-time reporting
What is revenue cycle management (RCM)?
RCM refers to the entire financial process of a patient visit—from appointment scheduling to final payment collection.
How does MCB optimize the revenue cycle?
By combining technology, expertise, and real-time analytics to ensure accurate billing, faster payments, and fewer denials.
Why outsource medical billing to a company like MCB?
Outsourcing frees up internal staff, reduces errors, improves revenue, and ensures compliance with constantly evolving regulations.
What are the benefits of working with a specialty-specific billing company?
Specialized knowledge leads to faster reimbursements, fewer mistakes, and better compliance with insurer requirements.
How often will I receive financial reports?
MCB provides regular, customizable reporting dashboards to keep your practice informed and in control.
Can outsourcing billing reduce overhead?
Yes, it eliminates the need for in-house billing staff and costly billing software, reducing expenses.
What is denial management?
It’s the process of identifying, appealing, and resolving denied claims to recover revenue.
How does MCB handle patient payment solutions?
We create custom programs for practices to help patients understand and manage their balances through secure payment portals.
What is a denied medical claim?
A claim that is rejected by an insurance payer due to errors, missing information, or coverage issues.
What KPIs should a practice track in RCM?
Key metrics include days in A/R, denial rate, clean claim rate, net collection rate, and patient payment rate.
For Practitioners & Practice Owners
Faq: Revenue Cycle Management
Stay informed on HIPAA rules, credentialing timelines, and administrative billing duties.
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For Office Managers & Compliance Officers
Faq: Compliance, Credentialing & Admin
Stay informed on HIPAA rules, credentialing timelines, and administrative billing duties.
What is medical credentialing?
Credentialing verifies a provider’s qualifications and authorizes them to treat patients and bill insurers.
How often does credentialing need to be updated?
Typically every 2-3 years, or sooner if there are major changes like relocating or switching payers.
What is HIPAA compliance in billing?
It means protecting patient data privacy and ensuring secure handling of health and billing information.
How does MCB ensure HIPAA compliance?
We follow strict protocols for data security, employee training, and secure communication channels.
What documents are required for provider credentialing?
Commonly required: licenses, DEA registration, malpractice insurance, education, and board certifications.
What are the risks of non-compliance in billing?
Non-compliance can lead to claim denials, audits, financial penalties, and damage to reputation.
How does MCB support credentialing services?
We manage all the paperwork, submissions, follow-ups, and renewals for provider credentialing and enrollment.
What are the 4 C's in healthcare compliance?
Correctness, Consistency, Confidentiality, and Communication—essential pillars of secure billing operations.
What are common billing audits and how can we prepare?
Audits may come from insurers or CMS. MCB prepares clients by ensuring proper documentation and coding.
Can MCB help with multi-state compliance?
Yes, we understand regional payer rules and help ensure compliance across all U.S. states.
Got More Questions? Let’s Talk.
Reach out for custom support or to learn more about our billing and credentialing services.
What are the 4 P’s in medical billing?
Patient, Provider, Payer, and Policy—core entities in any billing transaction.
What is the golden rule of medical billing?
Submit clean, accurate, and timely claims to minimize denials and maximize reimbursement.
What is the 4 P’s of healthcare?
Preventive, Predictive, Personalized, and Participatory—modern approaches to healthcare delivery.
What does adjudication mean in medical billing?
The process of insurance evaluating a claim to determine payment or denial.
What’s a claim adjustment reason code (CARC)?
CARCs explain the reasons a claim was paid differently than expected or denied.
What is a billing frequency code?
This code indicates whether the claim is original, corrected, or a replacement.
What is a D1 code in claim processing?
It’s a specific status code indicating a correction or duplicate claim submission.
What is a “quick claim” in medical billing?
It refers to expedited claim processing using automation or simplified workflows.
What does ‘claim pending adjudication’ mean?
It means the insurer has received the claim and is currently reviewing it.
What is a “ded003” claim code?
It usually refers to a deductible being applied before insurance payment—part of the patient’s responsibility.
Educational for All Audiences
Faq: Common Terms & Concepts
Clarify key billing terms, codes, and rules that matter to all healthcare professionals and patients.
