Faq

What is Medical Billing?

Medical billing is the process of submitting and following up on claims with insurance companies to receive payment for healthcare services provided to patients. It involves coding, claim submission, payment posting, and patient billing.

What is the difference between Medical Billing and Medical Coding?

Medical coding involves translating healthcare diagnoses, procedures, and medical services into standardized codes (ICD-10, CPT, HCPCS). Medical billing uses these codes to create claims and submit them to insurance companies for reimbursement.

How is One Source Medical Billing - HIPAA compliant, and what specific measures do you take to protect patient health information (PHI)?

HIPAA compliance is paramount for One Source Medical Billing San Antonio. We operate under strict Business Associate Agreements (BAAs) with all our clients. Our measures include end-to-end encryption for all data in transit and at rest, secure, audited data centers, multi-factor authentication for system access, and comprehensive employee training on HIPAA regulations and data handling protocols. We conduct regular internal and external security audits to ensure we meet and exceed all compliance requirements.

Are you available after hours for consultation or billing work ?

Yes we are available after hours, please call and schedule so that we can accommodate your request. 🙂

What are the most common Medical Billing errors?

Incorrect or missing patient information
Incorrect coding or mismatched codes
Duplicate billing
Billing for services not provided
Upcoding or undercoding

What is a Clearinghouse in Medical Billing?

A clearinghouse is an intermediary that processes and translates electronic claims between healthcare providers and insurance payers. It checks for errors before claims reach insurers, reducing denials.

What are denied and rejected claims?

Rejected Claim: A claim that cannot be processed due to missing or incorrect information (e.g., invalid patient ID). It must be corrected and resubmitted.
Denied Claim: A claim that has been processed but is not payable due to reasons such as lack of medical necessity or non-covered services. It may require an appeal.

How can you reduce claim denials?

Verify patient insurance before appointments
Ensure accurate coding and documentation
Submit claims on time
Use billing software and clearinghouses to check for errors
Follow up promptly on denied claims

What is the difference between in-network and out-of-network billing?

In-Network: Providers have contracts with the insurance company and accept negotiated rates.
Out-of-Network: Providers do not have a contract, and patients may pay higher costs.

What is an Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA)?

EOB: A statement from the insurance company detailing how a claim was processed, including payments and patient responsibility.
ERA: An electronic version of an EOB, providing payment details for multiple claims.

What is the difference between copay, coinsurance, and deductible?

Copay: A fixed amount a patient pays for a service (e.g., $25 per doctor visit).
Coinsurance: A percentage the patient pays after the deductible is met (e.g., 20% of the bill).
Deductible: The amount the patient must pay before insurance covers costs.

What is the appeals process for denied claims?

Review the denial reason in the EOB/ERA.
Gather supporting documentation (e.g., medical records, provider notes).
Submit an appeal letter within the insurance company’s timeframe.
Follow up regularly to track the appeal status.

Faq