Medical Billing Process & Claims FAQ
Clear operational answers covering daily claim submission, clearinghouse rejections, secondary insurance billing, and patient statement support.
Detailed Questions & Answers
Full-Service Medical BillingHow quickly are claims submitted after a patient encounter?
Once a clinician signs off on the EHR encounter note, VOPSS audits charges, scrubs codes against payer edits, and transmits electronic ANSI 837P/837I claims within 24 to 48 business hours.
How long do insurance carriers take to pay clean electronic claims?
Original Medicare Part B carries a statutory 14-day payment floor for electronic claims, while most major commercial PPO/HMO carriers adjudicate clean electronic submissions within 14 to 28 calendar days.
What is the difference between a clearinghouse rejection and a payer denial?
A clearinghouse or 277CA gateway rejection stops a claim prior to adjudication due to subscriber ID, demographic, or NPI/taxonomy formatting errors and is fixed within 24 hours. A denial occurs during adjudication on an 835 remittance and requires a formal corrected claim or clinical appeal.
How do you prevent unbilled visits or missing hospital consult charges?
We perform daily charge reconciliation comparing kept clinic appointments, surgical schedules, and hospital rounding lists against exported superbills so zero completed encounters remain unbilled.
How are secondary and tertiary insurance claims processed?
For Medicare Medigap plans with active COBA agreements, claims cross over electronically. When automatic crossover does not occur, our team transmits electronic secondary 837 claims containing Loop 2320/2430 primary adjudication segments within 48 hours of primary ERA posting.
Who answers phone calls when patients have questions about their statements?
VOPSS provides a dedicated, HIPAA-compliant patient billing support desk to explain Explanation of Benefits (EOB) cost-sharing, update secondary insurance info, and process authorized payment plans.
Do insurance payments go into VOPSS accounts or directly into our clinic bank account?
100% of insurance EFT deposits, paper payer checks, and patient portal payments go directly into your practice's own bank account. VOPSS never holds custody of your clinical funds.
How do you handle aged Accounts Receivable left behind by a previous biller?
During onboarding, we run a dedicated legacy A/R cleanup workqueue prioritizing claims nearing timely-filing deadlines and high-dollar 60–120+ day commercial balances alongside your new daily claims.
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Have a practice-specific billing question?
Speak directly with an AAPC-certified revenue cycle specialist or request a complimentary 90-day billing audit.