Medical billing: what to know
What the job involves, what changes the price, and what to ask a pro.
What medical billing is
A biller submits claims to insurers for a medical practice, follows up on denials, posts payments and bills patients so the practice is paid for its services. Practices outsource this when billing takes too much staff time or claims are being denied. This is general information, not legal or financial advice.
Signs you need it
- Claims are being denied or sit unpaid for a long time
- Your staff is spending more time on billing than on patients
- You are opening a new practice and need claims set up correctly
- Patient statements go out late or contain errors
- You are not sure which codes were billed for which visits
- You are changing billing systems or insurance contracts
What the pro does
- Set up the practice's payer enrollments and billing system
- Check patient insurance and benefits before visits when requested
- Review visit notes and codes for accuracy and completeness
- Submit claims to insurers and track their status
- Work denials and appeals and post payments
- Send patient statements and report results to the practice
What changes the price
Every job is different, so we do not publish prices. These are the things that move the quote up or down.
- Practice size and specialty
- Number of claims each month
- Payers the practice works with
- Whether eligibility checks and credentialing support are included
- How many past claims need cleanup
- Software the practice uses
- How the biller is paid: flat, per claim or a share of collections
What a written quote should spell out
- Services included: claims, denials, patient billing, credentialing support
- How the fee is calculated, in writing
- Reports you will receive and how often
- Who owns the data and how you get it if you leave
- Privacy and security practices
Questions to ask before you hire
- Do you have experience with my specialty?
- Will you sign an agreement to protect patient information?
- How do you handle denials and appeals?
- What reports will I get each month?
- How are you paid, and does it change with the claims you submit?
- Who is responsible for coding questions, my staff or yours?
- What happens to my data if I end the contract?
Red flags
- A biller who wants to change codes without clinical documentation
- No privacy agreement for patient information
- Payment tied to higher claim amounts in a way that encourages overcoding
- Refusing to share reports or data
- A biller who will not explain how denials are handled
What you can do yourself
A small practice can learn the basics of claim submission and track denials in a spreadsheet. Keep documentation complete and review denial reasons. Consider help when claims pile up or compliance is a concern. A compliance professional or attorney can answer legal questions.
Licenses and permits
Billing generally does not need a license, though coders may hold certifications and the work must follow privacy and billing rules. Ask about certifications and check them with the issuing organization, and ask for a written privacy agreement.
Medical billing questions
Is a biller the same as a coder?
Not always. Coders assign codes to services. Billers submit and follow claims. Some do both.
Who is responsible if a claim is wrong?
Terms vary. Ask for it in writing.
Can a biller guarantee payment?
No. Insurers decide under their rules.
Pro reviewers
Pros who offer medical billing remotely can improve this guide, like Wikipedia. We check every edit before it goes live. Every approved edit is credited in the edit history and on the pro's profile.
Edit history
- Oct 29, 2026: Drafted by infinibell to our content guidelines.
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