Medical Billing 101: A Step-by-Step Guide for New Providers

Setting up your practice is exciting, but billing can be a challenge. Not very much. As a healthcare provider—whether a therapist, nurse practitioner or someone else—you need to understand billing to manage your business and receive your payments. At SHMEDEX, we manage all your practice requirements, such as billing, coding, credentialing, and AR follow-up.

Besides handling submissions, we also check coverage, enter correct notes, apply accurate codes with modifiers, and stay on top of unpaid bills. This guide explains the billing process step-by-step so you can work smarter, avoid costly errors, and denial management.

Step 1: Get Credentialed with Insurance Companies

The first step is to be certified by insurance companies. You can't bill insurance until you have finished credentialing and signing contracts with the carriers. At SHMEDEX, we assist you all the way through credentialing, ensuring everything is accurately submitted. You can start your insurance billing quickly and without any unnecessary delay. It involves:

• Filing out and submitting insurance claims.
• Regularly updating your CAQH profile.
• Sharing documents showing licensing, malpractice, prior employment, etc.
• A big delay may occur, as approval takes a long time (usually 60–120 days).s

Step 2: Verify Patient Insurance and Eligibility

At SHMEDEX, we use resources such as availability and insurance portals to help you check this information quickly and correctly. We ensure there are no billing surprises later on. Before each visit, be careful to check:

• The patient's insurance is active.
• Your services are covered under their plan.
• Copayments, deductibles, and coverage restrictions.

Step 3: Document the Visit and Generate a Superbill

After the session is over, it's important to record all necessary details to support billing, treatment planning, and compliance. Remember to be sure:

• Summarize the session in your progress note.
• Enlist the date, time, provider info, and fees
• Use correct ICD-10 codes to describe your patient’s illnesses.
• Apply the accurate CPT codes.

Step 4: Claim Submission to the Insurance

Once the superbill is ready, submit the claim:

• Electronically using your billing software or EHR.
• Straight to a clearinghouse, which verifies it for mistakes before sending it to payers.
• It is vital to file on time. Claims have to be filed within a specific time frame, usually 90 to 180 days.

Step 5: Track and Manage Claim Responses

After filing your claim, the insurer (payer) will check the details and send you a response. After getting their response, you need to take the next appropriate action. Here is what might take place:

• After receiving your claim, the payer examines it and submits it for review.
• You get a payment, or the payer notifies your mailbox

The reason for a counter-claim is that:

• All expenses and charges are paid in full, and everything is approved
• A portion was paid with an Explanation of Benefits (EOB) that outlines what was covered and the reasons
• Your claim is not approved because there are errors, missing information, or no coverage
• Check the Explanation of Benefits (EOB)
• Deal with any claims that do not get accepted by handling the needed corrections
• Resubmit the modified claims as soon as you can

Step 6: Send Invoices to Patients (If Needed)

After insurance pays, the patient may owe:

• A copy
• A deductible
• A coinsurance portion
• Payment in full if insurance denies coverage
• Send clear, timely invoices and offer payment options.

Step 7: Post Payments and Reconcile

Log payments from insurance and patients in your system. Make sure:

• All claims are matched to services.
• Monitor outstanding payments regularly.
• Resolve claim denials quickly.
• Balances are updated.
• Denials are addressed.

Step 8: Stay Compliant and Keep Records Secure

Complying with regulations and storing records safely is a legal requirement and also necessary for operating a trustworthy and efficient healthcare practice.

• HIPAA compliance is required for healthcare organizations.
• Properly safeguarding the data of patients and their billing amount.
• Administering regular audits and document reviews.
• Assigning access rights according to a person’s function.
• Monitoring backup and recovery strategies.

Closing Remarks

When you’re starting your medical practice, all the paperwork, insurance matters, and keeping track of payments can be truly stressful. We can change things. If you have support and a basic process, billing can be easier, you'll get paid more quickly, and you won't feel as tired. Rather than trying to figure out the system, you should focus more on looking after your patients.

1. Evaluate and invest in AI-powered billing solutions
2. Train staff on emerging technologies and processes
3. Implement patient-friendly billing tools
4. Partner with billing services that stay ahead of trends
5. Regularly assess and optimize their revenue cycle management

At SHMEDEX, we help new providers streamline their billing and remove stress from the process. We handle all the requirements, cover your registration with different insurance companies, ensure you are properly insured, file your claims, follow up on payments, and note any denials. We take care of the challenging tasks, which gives you more time to focus on your patients. Hence, we are here to assist and handle all your billing-related tasks starting from billing, coding, credentialing, and many others. So, reach out to us at SHMEDEX without thinking twice!