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Medical Claims

Medical Claims Explained: Payer Types, Claim Forms, Coding Basics, Billing Workflow

November 22, 2023 / Alex J. Lau / Medical Claims
White Female Medical Billing Outsourced

A medical claim is the formal request a healthcare provider submits to an insurance payer asking for reimbursement for services delivered to a covered patient. Every claim contains standardized codes identifying the diagnosis, the procedure performed, and the provider who delivered care, along with patient demographics, insurance information, and the amount billed. The payer reviews […]

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Claim Denials, Claim Rejection, Denial Management, Medical Billing, Medical Claims

Why Aren’t Patients Using Patient Portals?

December 17, 2022 / Alex J. Lau / Healthcare, Healthcare Delivery, HIPAA, HIPAA Compliant, Medical, Medical Claims, Medical Providers, Patient Portal

Why Your Patients are Failing to Use Your Portal Properly Patient Portal Challenges Healthcare consumers vary from tech-savvy Generation Z, Y and Millennials, familiar with rapid click-throughs, to straightforward answers, to patients with little or no faith or proficiency in computing tools. In any instance, just a few words can sum up the probable value-added […]

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Confusion, Medical Patients, Medical Practice, Patient Portal, Patient Portal Problems, Security

What is Revenue Leakage and How to Stop It?

February 9, 2022 / Alex J. Lau / Medical Billing, Medical Billing Cost, Medical Billing Outsourcing, Medical Claims, Medical Providers, Revenue Cycle Management, Revenue Cycle Management Challenges, Revenue Leakage
Revenue Cycle Management Coins

“Revenue leakage” describes circumstances wherein a healthcare provider has supplied care to a patient but doesn’t collect payment. In general, it happens when accounts receivable (AR) continue to be unpaid for too long and are inadvertently overlooked. The longer an account receivable remains outstanding, the less likely healthcare providers are to retrieve payment, even in […]

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A/R, Healthcare, Healthcare Denials, Healthcare Reimbursement, Healthcare Revenue Cycle, Medical Billing, Medical Billing Denials, RCM, RCM Challenges, RCM Essentials, RCM Support

Medical Billing Issues Affecting Healthcare Provider Revenue

July 20, 2021 / Alex J. Lau / Medical Billing, Medical Billing Companies, Medical Claims
Medical Billing Specialist

Healthcare Practice Revenue Affected by Medical Billing Issues Let’s say a patient comes in and gives you his or her Medicare card. The front desk carefully records the information and billing submits the charge to Medicare. But the claim is rejected, maybe even from the clearinghouse. The problem? The patient thinks he’s simply on Medicare, […]

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Healthcare Billing, Medical Billing, Medical Billing Service, Medical Claims, Outsource Billing, Outsource Medical billing, Outsourced Billing

Recent Posts

  • Denied Medical Claim Appeal Letter

    Why an Approved Authorization Can Still End in a Denied Claim

  • AI Scribes Changing Medical Coding and Billing

    AI Scribes are Changing Medical Coding, Reimbursement

  • Net Collection Rate, analyzed by analyst

    What’s a Net Collection Rate in RCM?

  • Modifier 96 versus Modifier 97

    Modifier 96 vs. Modifier 97: What Therapy Billers Need to Know

  • 'Revalidation versus Recredentialing' Neon Sign

    Revalidation vs. Recredentialing: What’s the Difference? (2026 Guide)

  • Ghost Provider or Doctor Roaming the Hallways of a Hospital

    The Ghost Provider Problem: CAQH Lapse & Denials

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Recent Posts

  • Denied Medical Claim Appeal Letter

    Why an Approved Authorization Can Still End in a Denied Claim

  • AI Scribes Changing Medical Coding and Billing

    AI Scribes are Changing Medical Coding, Reimbursement

  • Net Collection Rate, analyzed by analyst

    What’s a Net Collection Rate in RCM?

  • Modifier 96 versus Modifier 97

    Modifier 96 vs. Modifier 97: What Therapy Billers Need to Know

  • 'Revalidation versus Recredentialing' Neon Sign

    Revalidation vs. Recredentialing: What’s the Difference? (2026 Guide)

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