Medical Billing: Difference between revisions

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Information for each patient encounter is used for medical billing. The DX (condition of the patient) and CPT (service rendered to the patient) are used when generating proper medical codes for billing. ICD-10 and CPT codes can easily be extracted from the patient encounter and entered into an invoice used for medical billing. The coding information is used to generate HCFA 1500 (CMS 1500) forms for insurance submission or the information can be submitted electronically through EDI (Electronic Data Interchange) to a medical billing clearinghouse. WebShuttle will guide you through the medical billing process with tools and reminders that make it easy.
The Medical Billing & Claims features in VEHRDICT are built to help your practice manage the entire revenue cycle—from capturing billing codes to tracking payments and resubmitting denied claims. This support page explains how each part of the billing workflow functions in the system, and how you can use VEHRDICT to ensure faster reimbursements and fewer billing errors.


===CPT/ICD code selection and AI extraction===
When documenting a patient encounter, VEHRDICT automatically scans the clinical notes and suggests appropriate CPT and ICD-10 codes based on the content. These AI-suggested codes appear in the billing section of the encounter for your review. You can accept, remove, or manually add additional codes as needed. If your practice uses a set of common codes frequently, you can mark them as favorites so they are easy to access and reuse for future visits.


    <p>Medical billing is a crucial process in healthcare, ensuring that healthcare providers are reimbursed for their services. The following guide outlines the key steps involved in medical billing, from patient encounters to insurance verification and claims submission.</p>
===Claim generation and clearinghouse submission===
Once billing codes and patient insurance information are finalized, VEHRDICT can generate a claim with just a few clicks. The system automatically formats the claim according to ANSI 837P standards and submits it to your connected clearinghouse. You don’t need to export files or handle separate billing software—everything happens directly from within the EHR. Each claim is assigned a tracking ID, and the status is monitored continuously for updates such as accepted, rejected, or paid.


    <h2>Patient Encounters</h2>
===Eligibility verification===
    <p>During a patient encounter, whether it's an office visit or a telemedicine call, the provider documents the details of the patient's condition and the services rendered in the EHR (Electronic Health Record) system. This includes:</p>
Before submitting a claim or even during check-in, VEHRDICT allows you to verify a patient's insurance eligibility in real time. This feature connects to insurance payers electronically and confirms active coverage, plan details, and co-pay information. You can access the verification results from the patient profile or directly from the appointment screen. Verifying eligibility ahead of time helps reduce claim denials and prevents surprises for both the practice and the patient.
    <ul>
        <li><strong>Recording Condition and Services</strong>: Detailed documentation of the patient's condition and services provided.</li>
        <li><strong>Transcription</strong>: Audio or video from the encounter is sent for transcription. Transcriptionists convert this into standard documents (e.g., History and Physical, Consultation, Operative Report).</li>
        <li><strong>Documentation</strong>: Transcribed documents are attached to the patient chart in the EHR system, capturing the complete condition of the health record.</li>
    </ul>


    <h2>Insurance Verification</h2>
===Payment posting===
    <p>Verifying patient insurance information is essential to ensure eligibility and policy benefits are documented. This step includes:</p>
When payment information is received from the clearinghouse or entered manually, VEHRDICT makes it easy to post payments to the correct patient account. The system can automatically match Explanation of Benefits (EOB) data with submitted claims, and apply payments, adjustments, or patient balances accordingly. Staff can view posted payments in the billing history section and apply filters to review specific services, dates, or payers.
    <ul>
        <li><strong>Eligibility Check</strong>: Confirming that the patient’s insurance is valid and active.</li>
        <li><strong>Policy Benefits</strong>: Understanding the coverage details, co-pays, deductibles, and out-of-pocket expenses.</li>
        <li><strong>Prior Authorization</strong>: Obtaining necessary authorizations from the insurance company for certain procedures or treatments.</li>
    </ul>
    <img src="path/to/your/insurance_verification_image.png" alt="Insurance Verification">


    <h2>Medical Coding</h2>
===Denial management and resubmissions===
    <p>Medical coding involves extracting codes from transcribed information to represent the patient's condition and services rendered. This process includes:</p>
If a claim is denied or returned with errors, VEHRDICT highlights the issue and provides guidance on what needs to be corrected. You can open the claim, make the necessary adjustments, and resubmit it directly through the system without re-entering all the data. All denial reasons and resubmission attempts are logged, allowing your staff to track patterns and reduce repeat issues. This helps ensure quicker resolutions and fewer delays in reimbursement.
    <ul>
        <li><strong>ICD-10 and CPT Codes</strong>: Using standardized codes to describe the patient's condition (DX) and services rendered (CPT).</li>
        <li><strong>Coder Expertise</strong>: Experienced medical coders review and assign appropriate codes to ensure accuracy.</li>
    </ul>


    <h2>Entering Medical Charges</h2>
===Patient invoicing and receipts===
    <p>Charges for services rendered are entered into the patient invoice. This involves:</p>
VEHRDICT can generate detailed invoices for patient balances, including charges, payments, and adjustments. You can print or email invoices directly from the system, and each invoice includes your practice’s information and payment instructions. When a payment is made, a receipt can be issued immediately. This ensures that patients are well-informed of their financial responsibility and that your practice maintains clear and professional billing records.
    <ul>
        <li><strong>Assigning Values</strong>: Each service is assigned a specific charge based on standardized rates.</li>
        <li><strong>Invoice Creation</strong>: The billing sheet is prepared, ensuring it is complete and error-free.</li>
    </ul>


    <h2>Charge Transmission</h2>
    <p>Submitting claims to the insurance company is a critical step, known as charge transmission. This can be done electronically through EDI (Electronic Data Interchange). Key points include:</p>
    <ul>
        <li><strong>EDI Submission</strong>: Secure and encrypted electronic submission of claims.</li>
        <li><strong>Error Checking</strong>: Ensuring all mandatory fields are correctly filled to prevent claim rejections.</li>
    </ul>
    <img src="path/to/your/charge_transmission_image.png" alt="Charge Transmission">


    <h2>Denial Management</h2>
    <p>Handling denied claims involves:</p>
    <ul>
        <li><strong>Follow-Up</strong>: Timely follow-up on denied claims to correct issues and increase the chances of payment.</li>
        <li><strong>Evaluation</strong>: Understanding the reasons for denials and taking corrective actions to prevent future issues.</li>
        <li><strong>Prioritization</strong>: Focusing on high-priority denials by payer and amount to maximize reimbursements.</li>
    </ul>


    <h2>Posting Payments</h2>
== Insurance Verification ==
    <p>Once payments are received, they need to be posted in the EHR system. This includes:</p>
    <ul>
        <li><strong>EOB and ERA</strong>: Processing Explanation of Benefits and Electronic Remittance Advice from insurance companies.</li>
        <li><strong>Payment Posting</strong>: Applying the correct payment amounts to each invoice from bulk payments.</li>
    </ul>


    <h2>Example Screenshots</h2>
Before billing, it is essential to confirm the patient’s insurance status and understand their benefits. This ensures coverage and reduces claim denials.


    <h3>Invoice List</h3>
    <img src="path/to/your/invoice_list_image.png" alt="Invoice List">
    <p>The invoice list shows detailed information about each patient encounter, including encounter ID, date, patient name, code text, claim status, number of items, total charges, payments, and amount due.</p>


    <h3>Apply Payment</h3>
* '''Eligibility Check''' – Confirm policy is active
    <img src="path/to/your/apply_payment_image.png" alt="Apply Payment">
* '''Policy Benefits''' – Review co-pays, deductibles, and coverage limits
    <p>The apply payment screen allows administrators to enter payment details, including check/ref number, check date, deposit date, payment type, payer, and payment amount.</p>
* '''Prior Authorization''' – Secure approvals for procedures if required


    <p>By following these steps, the medical billing process can be streamlined and efficient, ensuring accurate and timely reimbursements for healthcare services provided.</p>
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Information for each patient encounter is used for medical billing.   The DX (condition of the patient) and CPT (service rendered to the patient) are used when generating proper medical codes for billing.  ICD-10 and CPT codes can easily be extracted from the patient encounter and entered into an invoice used for medical billing.  The coding information is used to generate HCFA 1500 (CMS 1500) forms for insurance submission or the information can be submitted electronically through EDI (Electronic Data Interchange) to a medical billing clearinghouse.  WebShuttle will guide you through the medical billing process with tools and reminders that make it easy.
[[File:insurance_eligibility_nx.jpg|800px|'''Insurance Verification Screen''' – Review eligibility, coverage, and authorization status.]]




[[File:Medical billing 2.jpg|800px]]


== Medical Coding ==


==Insurance Verification==
Once documentation is complete, coders extract:




It is necessary to verify patient insurance information to ensure that eligibility and policy benefits are documented.  This determines whether the insurance claim can be obtained for services rendered.  Patient responsibilities such as co-pay, deductibles and out-of-pocket expenses need to be entered.  With some services, prior authorization is required from the insurance company. 
* '''ICD-10 Codes''' – Patient diagnoses (DX)
* '''CPT Codes''' – Services performed




[[File:Insurance screen.jpg|800px]]
Accurate coding is vital for correct billing and compliance with insurance regulations. Experienced coders ensure codes reflect the medical necessity and scope of service.




==Patient Encounters==
{{Tip|Coding errors are one of the top reasons for claim denials. Always double-check code pairings and modifier usage.}}




When the provider encounters a patient during an office visit or telemedicine call, the details of the condition and service are documented in the EHR system.  Audio or video are sent for transcription and all results are documented.  The details can be recorded during the encounter or after the visit or call.  Information about the medications and condition are all documented.  Information from the encounter is used during coding.


== Entering Medical Charges ==


==Transcription==
Charges are entered into the system based on documented services:




Recorded audio or video is routed for medical transcription.  The transcriptionist will convert audio to standard documents such as a History and Physical, Consultation, Operative Report, Letter, Discharge Summary or any custom document.  Transcribed documents are automatically attached to the patient chart in the EHR system.  The transcribed document contains the complete condition of the health record.  Information from medical transcription will be used during coding.
* '''Assigning Charges''' – Each CPT code is linked to a standardized billing rate
* '''Invoice Creation''' – Review for completeness and accuracy before submission




==Medical Coding==
This creates a billing record used for claim generation and submission.




Medical codes are extracted from the transcribed information.  The patient's condition, medical services rendered, medical prescriptions are all converted into medical codes.  The complete medical history is condensed into medical codes.  Experienced medical coders are often involved in the medical coding process.  Coders usually extract the DX (condition of the patient), CPT (service rendered to the patient) when generating proper medical codes for billing.


== Charge Transmission ==


==Entering Medical Charges==
Sending claims to payers is done via secure EDI (Electronic Data Interchange):




Charges for services rendered will be entered into the patient invoice.  Appropriate values are assigned to each of the services rendered.  These charges will then be sent to the medical billing company (clearinghouse) or directly to the insurance company for a claim.  The billing sheet must be complete and free of errors or it may reflect during a claim.  Accuracy is very important during claim submission.
* '''EDI Submission''' – HIPAA-compliant, encrypted claim transmission
* '''Error Checking''' – Automated checks to reduce rejections




[[File:Medical billing 2.jpg|800px]]
'''VEHRDICT''' tools assist in preparing, reviewing, and transmitting claims efficiently.




==Charge Transmission==
{{Tip|Use the EDI error checker to catch missing diagnosis codes, date mismatches, or NPI errors before submission.}}


Transmitting the claims to the insurance company is called Charge transmission.  Electronic submission is called EDI (Electronic Data Interchange).  EDI is secure and encrypted.  Claims need to be without errors when transmitting through EDI.  Errors can result in the following:


1.  Mandatory fields need to be filled without errors.  Claims with errors will be rejected.
2.  Invalid information in the patients health record will cause the claim to be rejected by the EDI.
3.  Claims can be rejected due to insurance guidelines and payer details.


Denials need to be processed if a claim is rejected or not approved.
== Denial Management ==


For denied claims, follow-up is essential:


==Calling about Denials==


* '''Tracking and Follow-Up''' – Monitor status and resolve issues
* '''Root Cause Evaluation''' – Identify and address denial reasons
* '''Priority Handling''' – Focus efforts based on claim value and payer


In many cases, it is necessary to to follow-up on denied claims to correct issues that prevented payment.  Following up in a timely manner increases the chances of claims being paid.  The goal is to receive payment for all services rending by the healthcare providers.  Often, patient information is supplied and errors are rectified.


{{Warning|Denials left unresolved can result in significant revenue loss. Implement a daily check of pending/denied claims.}}


==Denial Management==




Learning from prior denials and taking appropriate actions to correct issues is an important step in improving RCM (Revenue Cycle Management).  Denial management is an important step in maximizing payment for services rendered.  Determining the causes of denials will reduce the risk of future denials.  A proper course of action should be takes after evaluating denied claims by the denial management team.  Denied claims should be prioritized by payers and amounts to maximize reimbursements.
== Payment Posting ==


Once insurance payments are received:




==Posting Payments==
* '''EOB & ERA Review''' – Cross-reference with expected charges
* '''Apply Payments''' – Match incoming payments with corresponding invoices




Payments received will need to be posted into the EHR software.  Correspondence, EOB (Explanation of benefits), and ERA (Electronic Remittance Advice) will received from the insurance companies.  The proper amount will need to be posted to each invoice from bulk payment receivables.
Accurate posting ensures financial reporting and patient balance accuracy.




[[File:Payment posting.jpg|800px]]
 
== Example Screenshots ==
 
=== Invoice List ===
 
 
[[File:Invoice_list.png|800px|'''Invoice List''' – View encounters, claim statuses, total charges, payments, and balance due.]]
 
 
=== Apply Payment ===
 
 
 
[[File:Apply_payment.png|800px|'''Apply Payment Screen''' – Enter and reconcile payment details from insurance payers.]]
 
 
 
== Summary ==
 
By following these steps in the '''VEHRDICT''' system, your practice can streamline billing workflows, minimize errors, and ensure fast and accurate reimbursements for all patient services.

Latest revision as of 23:22, 15 July 2025

The Medical Billing & Claims features in VEHRDICT are built to help your practice manage the entire revenue cycle—from capturing billing codes to tracking payments and resubmitting denied claims. This support page explains how each part of the billing workflow functions in the system, and how you can use VEHRDICT to ensure faster reimbursements and fewer billing errors.

CPT/ICD code selection and AI extraction

When documenting a patient encounter, VEHRDICT automatically scans the clinical notes and suggests appropriate CPT and ICD-10 codes based on the content. These AI-suggested codes appear in the billing section of the encounter for your review. You can accept, remove, or manually add additional codes as needed. If your practice uses a set of common codes frequently, you can mark them as favorites so they are easy to access and reuse for future visits.

Claim generation and clearinghouse submission

Once billing codes and patient insurance information are finalized, VEHRDICT can generate a claim with just a few clicks. The system automatically formats the claim according to ANSI 837P standards and submits it to your connected clearinghouse. You don’t need to export files or handle separate billing software—everything happens directly from within the EHR. Each claim is assigned a tracking ID, and the status is monitored continuously for updates such as accepted, rejected, or paid.

Eligibility verification

Before submitting a claim or even during check-in, VEHRDICT allows you to verify a patient's insurance eligibility in real time. This feature connects to insurance payers electronically and confirms active coverage, plan details, and co-pay information. You can access the verification results from the patient profile or directly from the appointment screen. Verifying eligibility ahead of time helps reduce claim denials and prevents surprises for both the practice and the patient.

Payment posting

When payment information is received from the clearinghouse or entered manually, VEHRDICT makes it easy to post payments to the correct patient account. The system can automatically match Explanation of Benefits (EOB) data with submitted claims, and apply payments, adjustments, or patient balances accordingly. Staff can view posted payments in the billing history section and apply filters to review specific services, dates, or payers.

Denial management and resubmissions

If a claim is denied or returned with errors, VEHRDICT highlights the issue and provides guidance on what needs to be corrected. You can open the claim, make the necessary adjustments, and resubmit it directly through the system without re-entering all the data. All denial reasons and resubmission attempts are logged, allowing your staff to track patterns and reduce repeat issues. This helps ensure quicker resolutions and fewer delays in reimbursement.

Patient invoicing and receipts

VEHRDICT can generate detailed invoices for patient balances, including charges, payments, and adjustments. You can print or email invoices directly from the system, and each invoice includes your practice’s information and payment instructions. When a payment is made, a receipt can be issued immediately. This ensures that patients are well-informed of their financial responsibility and that your practice maintains clear and professional billing records.


Insurance Verification

Before billing, it is essential to confirm the patient’s insurance status and understand their benefits. This ensures coverage and reduces claim denials.


  • Eligibility Check – Confirm policy is active
  • Policy Benefits – Review co-pays, deductibles, and coverage limits
  • Prior Authorization – Secure approvals for procedures if required


Insurance Verification Screen – Review eligibility, coverage, and authorization status.


Medical Coding

Once documentation is complete, coders extract:


  • ICD-10 Codes – Patient diagnoses (DX)
  • CPT Codes – Services performed


Accurate coding is vital for correct billing and compliance with insurance regulations. Experienced coders ensure codes reflect the medical necessity and scope of service.


Tip: Coding errors are one of the top reasons for claim denials. Always double-check code pairings and modifier usage.



Entering Medical Charges

Charges are entered into the system based on documented services:


  • Assigning Charges – Each CPT code is linked to a standardized billing rate
  • Invoice Creation – Review for completeness and accuracy before submission


This creates a billing record used for claim generation and submission.


Charge Transmission

Sending claims to payers is done via secure EDI (Electronic Data Interchange):


  • EDI Submission – HIPAA-compliant, encrypted claim transmission
  • Error Checking – Automated checks to reduce rejections


VEHRDICT tools assist in preparing, reviewing, and transmitting claims efficiently.


Tip: Use the EDI error checker to catch missing diagnosis codes, date mismatches, or NPI errors before submission.



Denial Management

For denied claims, follow-up is essential:


  • Tracking and Follow-Up – Monitor status and resolve issues
  • Root Cause Evaluation – Identify and address denial reasons
  • Priority Handling – Focus efforts based on claim value and payer


Warning: Denials left unresolved can result in significant revenue loss. Implement a daily check of pending/denied claims.



Payment Posting

Once insurance payments are received:


  • EOB & ERA Review – Cross-reference with expected charges
  • Apply Payments – Match incoming payments with corresponding invoices


Accurate posting ensures financial reporting and patient balance accuracy.


Example Screenshots

Invoice List

Invoice List – View encounters, claim statuses, total charges, payments, and balance due.


Apply Payment

Apply Payment Screen – Enter and reconcile payment details from insurance payers.


Summary

By following these steps in the VEHRDICT system, your practice can streamline billing workflows, minimize errors, and ensure fast and accurate reimbursements for all patient services.

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