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Medicaid Billing basics for better revenue cycle

Healthcare Billing & Medicaid Billing Basics

Healthcare billing is the backbone of every successful medical practice. It ensures providers receive timely and accurate reimbursement for the care they deliver. Whether you are a small private clinic or a large federally qualified health center (FQHC), having a solid billing process helps maintain cash flow, reduces denials, and keeps your revenue cycle healthy.

What is Healthcare Billing?

Healthcare billing is the process of translating medical services into standardized codes, submitting claims to insurance companies (including government payers like Medicare and Medicaid), and following up to ensure payment is received. A typical revenue cycle includes:

  • Patient Registration & Insurance Verification – Capturing accurate demographic and coverage information.
  • Medical Coding – Assigning CPT®, HCPCS, and ICD-10 codes that represent the services performed and diagnoses treated.
  • Claim Submission – Sending electronic claims (EDI 837) through a clearinghouse or directly to payers.
  • Payment Posting & Reconciliation – Recording payments, adjustments, and patient responsibility.
  • Denial Management & Appeals – Correcting and resubmitting denied claims.

A well-structured billing process minimizes revenue leakage and ensures compliance with payer requirements.

Medicaid Billing Basics

Medicaid is a joint federal and state program that provides health coverage for low-income individuals and families. Billing Medicaid correctly is critical because rules can vary from state to state and claims must meet strict requirements.

Key things to know about Medicaid billing:

  • Eligibility Verification – Medicaid eligibility can change monthly. Always verify coverage before each visit.
  • Prior Authorizations – Some services (such as certain medications, surgeries, or therapy sessions) require approval before being rendered.
  • Timely Filing – Each state has deadlines (often 90–365 days from the date of service) for submitting claims.
  • Encounter Reporting – FQHCs and other safety-net providers often must submit encounter-level data for cost-based reimbursement.
  • Coordination of Benefits – If the patient has other coverage, Medicaid is usually the payer of last resort.

Getting Medicaid billing right reduces denials, speeds up payment, and helps you stay compliant with state and federal regulations.

Why Work with a Professional Billing Team

Healthcare billing can be complex, especially when navigating Medicaid requirements. Partnering with experienced billing professionals ensures your claims are coded correctly, submitted on time, and followed up promptly. This allows your providers to focus on what they do best — delivering quality patient care — while your revenue cycle stays healthy and compliant.

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