Healthcare Network Associates

Denver, CO 80203, USA
HIPAA Compliant

What Is Medical Billing? A Complete Beginner’s Guide

Medical Billing

What Is Medical Billing? A Complete Beginner's Guide

January 2025 7 min read HNA Billing Team

Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by a healthcare provider. It is the financial backbone of every medical practice — without accurate billing, providers cannot get paid for the care they deliver.

17%
Claims denied on first submission
$125B
Lost annually to billing errors
30%
Avg revenue boost with expert billing

What Is Medical Billing?

Medical billing translates healthcare services into billing claims. When a patient visits a doctor, services are documented in medical records. A medical biller converts those records into a standardized claim and submits it to the insurance company for reimbursement.

Key Difference: Medical billing and coding are often confused. Coding assigns standardized codes to diagnoses and procedures. Billing uses those codes to create and submit claims to insurance companies for payment.

The Medical Billing Process — Step by Step

01
Patient Registration & Insurance Verification
Before the patient is seen, insurance eligibility is verified — confirming active coverage, deductibles, copays, and whether prior authorization is needed.
02
Medical Coding
After the visit, a coder reviews clinical documentation and assigns ICD-10 diagnosis codes and CPT procedure codes. Accuracy here is critical — wrong codes cause denials.
03
Charge Entry
Assigned codes and fees are entered into the billing system creating a claim that matches the provider's fee schedule and payer contract rates.
04
Claim Scrubbing & Submission
Claims are checked for errors before submission. Clean claims are submitted electronically to payers via clearinghouses.
05
Payment Posting
After the payer processes the claim, an EOB is received. Payments are posted and underpayments are flagged for follow-up.
06
AR Follow-Up & Denial Management
Unpaid or denied claims are tracked and appealed with corrected claims or supporting documentation within 48 hours.
07
Patient Billing
After insurance payment, remaining balances are billed to the patient with clear statements and multiple payment options.

Common Medical Billing Challenges

  • Eligibility errors — patient insurance not verified before the visit
  • Incorrect or missing diagnosis codes causing automatic denials
  • Wrong modifiers applied to procedures
  • Missing prior authorizations before services are rendered
  • Timely filing deadlines missed — claims become uncollectable
  • Underpayments from insurance not caught or appealed
  • High patient balance write-offs due to poor collection processes

How HNA Improves Your Medical Billing

Healthcare Network Associates provides end-to-end medical billing services for 800+ practices nationwide. Our team of 1,100+ certified coders and billers delivers a 99% first-pass claim success rate, 48-hour denial response, and an average 30% increase in collections — with zero setup fees and no long-term contracts.

  • Specialty-trained billers who know your specific codes and payer rules
  • Real-time reporting dashboard — full visibility into every claim
  • Dedicated account manager assigned from day one
  • 48-hour denial response vs industry average of 5–7 days
  • HIPAA-compliant processes with signed BAA for every client
  • $0 setup fee and 14-day notice — no lock-in contracts

Ready to Maximize Your Practice Revenue?

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