Eligibility verification is the process of confirming a patient’s insurance coverage and determining their eligibility for specific healthcare services.

Pre-authorization, also known as prior authorization, is a process where an insurance company approves a medical procedure, service, or medication before it’s provided to the patient. It’s a way for insurers to ensure the treatment is medically necessary and appropriate, and to control costs. 

coding and charge entry/capture are closely related but distinct processes. Coding translates clinical documentation into standardized codes (like ICD-10 and CPT) for procedures, diagnoses, and services. Charge entry/capture then takes those codes and associated information (like patient demographics, insurance details, and fees) and accurately enters them into billing systems. This ensures proper billing and reimbursement from insurance companies and patients. 

Claim scrubbing is the process of reviewing medical claims for errors, inconsistencies, and missing information before submission to insurance companies. This helps prevent claim denials and ensures timely payment. Claim submission, after scrubbing, involves electronically transmitting the cleaned claim to the insurance provider.

Claims follow-up in medical billing involves proactively tracking and resolving unpaid or denied claims to improve cash flow and ensure timely reimbursement. It’s a critical part of revenue cycle management (RCM) in healthcare.

Rejection, Denial, & Appeal In the context of insurance and medical billing, a rejection usually means a claim was not processed due to errors or incomplete information, while a denial indicates the claim was processed but deemed unpayable by the insurer. If a claim is denied, an appeal can be filed to challenge the insurer’s decision, often requiring detailed documentation to support the claim. 

Payment Posting : Payment posting is the process of recording payments received by a business in an accounting system. It ensures accurate and up-to-date financial records, which is crucial for managing cash flow and preparing financial reports. In the context of medical billing, payment posting involves recording payments from insurance companies, patients, and government programs into the billing system. 

Patient Statement : A patient statement, also known as a patient bill or medical bill, is a document outlining services provided to a patient and the associated costs. It’s essentially a summary of the patient’s financial responsibility for healthcare services. These statements are typically sent to patients by mail or electronically and can clarify what services were provided, what was covered by insurance, and the patient’s remaining balance