healthcarebilling.org

Revenue Cycle Basics

A plain-language walkthrough of the healthcare revenue cycle — from the first appointment to the final payment.

Front-End Operations

Everything that happens before the patient is seen — scheduling, registration, insurance verification, and prior authorizations.

  • Eligibility verification at check-in
  • Collecting accurate patient demographics
  • Prior auth requirements by payer

Charge Capture & Coding

Translating clinical services into billable codes and making sure every service rendered is accurately documented.

  • CPT, ICD-10, and HCPCS code selection
  • Documentation supporting medical necessity
  • Modifier usage and CCI edits

Claims Submission & Payer Response

Submitting clean claims, tracking adjudication, and understanding EOBs, ERA files, and remittance advice.

  • Electronic vs. paper claim submission
  • Common rejection reasons and fixes
  • Reading payer remittance advice

Payment Posting & Follow-Up

Applying payments, managing denials, and following up on outstanding claims to close the revenue loop.

  • Payment posting and reconciliation
  • Denial management and appeals
  • Patient balance billing best practices