Ante Chin's Lingaw Moment

A perfect claim means nothing if it’s not submitted correctly!

You’ve entered the charges. You’ve reviewed the codes. You’ve checked the patient and insurance information.
Now what? 🤔
The next important step is claim submission.
A claim must be properly reviewed, validated, and submitted to the insurance payer. After submission, it is also important to monitor the claim and follow up on any rejections, denials, or missing information.
📋 The basic workflow:
✅ Review and validate
📤 Submit the claim
🔍 Track the claim status
📞 Follow up when needed
Remember: Clicking “Submit” is not the end of the process. A Medical VA should help make sure the claim was accepted and continues moving through the billing process.

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👉No charge entered = No claim submitted = No payment received.

Before a claim can be paid, the charge must be entered correctly.

Charge entry is an important step in the medical billing process. It involves entering the services provided to the patient into the practice management system so the claim can be created and submitted to the insurance company.

A small mistake in the patient information, date of service, CPT/HCPCS code, ICD-10-CM diagnosis code, units, charges, modifiers, or insurance information can affect the claim. ❌
That’s why accuracy matters from the very beginning of the billing process. ✅

📌 Remember: Accurate charge entry helps create clean claims and supports faster, smoother reimbursement.

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The claim was paid—but was the payment posted correctly?

A claim being paid is only part of the process. The payment must also be posted accurately in the practice management system.
Payment posting involves recording the insurance payment, applying adjustments, identifying patient responsibility, and reconciling the payment with the EOB or ERA.
Accurate payment posting helps keep patient balances correct and financial records clean.

✅
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What happens when a claim cannot move forward because something is missing or needs to be corrected? 🤔

It may be placed in a Hold Bucket.
A hold bucket helps organize claims that need attention—such as missing information, documentation, authorization, eligibility issues, or coding corrections.

For Medical VAs, the key is simple:
Identify → Investigate → Resolve → Follow Up → Get Paid. ✅

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Claims sitting in a hold bucket are not automatically lost—but ignoring them can cost the practice money.

What happens when a claim cannot move forward because something is missing or needs to be corrected? 🤔
It may be placed in a Hold Bucket.
A hold bucket helps organize claims that need attention—such as missing information, documentation, authorization, eligibility issues, or coding corrections.

For Medical VAs, the key is simple:
Identify → Investigate → Resolve → Follow Up → Get Paid. ✅
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An unpaid claim is not always a lost claim—it often just needs the right follow-up.

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Accounts Receivable (A/R) is one of the most important parts of the medical billing process. It focuses on tracking unpaid claims, identifying payment delays, and taking the necessary steps to help providers receive the reimbursement they're owed.

A skilled Medical VA understands that timely follow-up, accurate documentation, and attention to detail can make a significant difference in reducing outstanding balances.

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With Venus Lagare – I just got recognized as one of their top fans! 🎉

👉Every Medical VA involved in billing should know the difference between an Explanation of Benefits (EOB) and an Electronic Remittance Advice (ERA).

Although both explain how a claim was processed, they serve different purposes. Understanding when and how to use each document helps improve payment posting accuracy, reduces confusion, and supports a smoother revenue cycle.

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A denied claim doesn't always mean the service wasn't covered. More often, it's caused by avoidable errors such as incorrect patient information, missing prior authorization, coding mistakes, or incomplete documentation.
As a Medical VA, understanding the most common denial reasons can help improve claim accuracy, reduce rework, and speed up reimbursement.

📌 Save this guide for future reference. 💬 Which denial reason do you encounter most often in your work?

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Most claim denials are preventable.

A denied claim doesn't always mean the service wasn't covered—it often means something was missing, incorrect, or submitted too late.
Learning the most common denial reasons can help you reduce rework, speed up reimbursement, and become a more valuable Medical VA.

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