Medical Billing Process: 10 Steps From Patient Visit to Payment

By MedicureMD Billing Team. Reviewed by an AAPC-certified coder.

The medical billing process is everything that happens between a patient booking a visit and your practice getting paid. It has 10 steps, and a mistake at any one of them can delay payment or cause a denial. This guide walks through each step, shows where claims usually get stuck and explains who can take the work off your hands.

The medical billing process turns a patient visit into a paid claim. Your practice records what happened, turns it into codes, sends a claim to the insurance company and then follows up until the money arrives. Patients are billed for what insurance does not cover.

Some of this work happens before the patient arrives, and some happens months after. That is why it is easy for things to slip.

1. Patient registration

The front desk collects the patient’s name, date of birth, address and insurance details, and scans the insurance card. Typos here are one of the most common reasons claims get rejected later.

2. Insurance eligibility check

Before the visit, the practice confirms that the patient’s coverage is active and checks what the plan covers, including copays and deductibles. Doing this before the visit is far easier than fixing it after.

3. Prior authorization

Some services, such as certain imaging or procedures, need approval from the payer first. If authorization is required and missing, the claim will usually be denied.

4. Documenting the visit

The provider records the visit in the chart: what was done, why it was needed and the diagnosis. Coding can only be as good as this note.

5. Coding and charge entry

A coder turns the visit into standard codes: CPT codes for services, ICD-10 codes for diagnoses and HCPCS codes for supplies and some drugs. Coders certified through AAPC are trained to do this. The charges are then entered in the billing system.

6. Claim scrubbing

Before the claim is sent, software and staff check it for errors: missing information, wrong codes, mismatched modifiers. Fixing a claim now takes minutes. Fixing it after a denial takes weeks.

7. Claim submission

The claim is sent to the payer, usually through a clearinghouse. The clearinghouse checks the format and passes the claim on.

8. Payer review

The payer reviews the claim and decides what to do. A claim can be paid, partly paid, denied or rejected. A rejected claim failed a format check and was never processed, so it can be fixed and sent again. A denied claim was processed and refused, and usually needs an appeal or a correction.

9. Payment posting and denial management

When the payer pays, the practice posts the payment from the remittance advice (ERA or EOB) and compares it with the contracted rate. Denied claims are worked right away: find the reason, fix the problem and appeal before the deadline.

10. Patient billing and A/R follow-up

Whatever insurance does not pay, the patient is billed for. The team also keeps checking unpaid claims, starting with the oldest, until every balance is closed.

• Insurance details entered wrong at registration
• Eligibility not checked before the visit
• Authorization missed for services that need it
• Visit notes that do not support the codes billed
• Rejected claims left unfixed
• Denials that nobody has time to appeal
• Old unpaid claims that stop being followed

If you want to find out which of these affect your practice, use our medical billing audit checklist.

Practices usually choose one of two ways. They hire billers and coders in-house, or they hand the work to a billing company. In-house gives you direct control, but you pay for salaries, software and training, and billing slows down when someone is out. With outsourced medical billing services, a dedicated team runs the process for you and sends regular reports.

Any company that handles your patient data should sign a business associate agreement with you under HIPAA.

At MedicureMD, a U.S.-based team handles the whole medical billing process as part of our medical billing services and revenue cycle management, with a report every week. A good way to start is our free billing audit: we review your claims, denials, accounts receivable and coding, and send you a written report within 24 to 48 hours.

The medical billing process has 10 steps: patient registration, eligibility check, prior authorization, visit documentation, coding, claim scrubbing, claim submission, payer review, payment posting with denial management, and patient billing with A/R follow-up.

It depends on the payer and on whether the claim is clean. A claim that is correct the first time is paid faster than one that has to be corrected or appealed.

A rejected claim failed a format or data check and was never processed, so it can be fixed and resent. A denied claim was processed and refused, and usually needs a correction or an appeal.

Yes. Many practices hand all or part of it to a billing company. You keep your own EHR and patients, and the billing team handles claims, denials and follow-up.