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Medical Bill Breakdown: A Comprehensive Guide for Patients

Health Insurance Companies Process 1 in 5 Claims Wrong

How to Navigate the Medical Billing Process from Start to Finish

Most patients would agree that the healthcare system has become quite tricky to navigate. And if you ask those working in the field, especially in medical billing, they’ll agree that it has become overly complex from their end too.

So it was no surprise when the results of a 2014 public opinion survey by TransUnion Healthcare were published; even less shocking that the survey found 54% of patients are confused by their medical bills or patient statments.

Luckily, our friends from Medical Billing & Coding Certification (MB&CC) took note of the survey results also and decided to create a free comprehensive consumer guide.

Designed with patients in mind, here is a short snippet of how the guide can help:

This guide will help you, as a patient, navigate the medical billing process from the moment you contact a healthcare provider about an appointment until after you receive your bill in the mail. We discuss how healthcare providers determine costs and negotiate charges with your insurance provider. Finally, we show you how to identify and dispute erroneous charges on your bill.

The guide shows you how to read a medical bill.

Learn What Medical Bills Really Cover

From the outside looking in, medical fees can appear to have no rhyme or reason. But there are actually a number of criteria that healthcare providers must consider when setting their fee schedule.

Four of the most common criteria are briefly listed below and you can find greater detail about each in MB&CC’s guide.

  1. Facility capacity
  2. Supply and demand
  3. Hospital reputation
  4. Charge Description Master (CDM) lists

Even though this guide is intended as a resource for patients, it’s also a great reminder for all healthcare providers. With one in two patients struggling to understand their medical bills, providers have another opportunity to make a lasting impact.

Answering patients’ billing questions and explaining the process in clear terms is certainly time well-spent.

You can find the complete guide on MB&CC’s blog at: http://www.medicalbillingandcoding.org/health-insurance-guide/understanding-medical-bills/.

Need more clarification? Feel free to ask questions in the comments and we’ll answer!


is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

One Response to Medical Bill Breakdown: A Comprehensive Guide for Patients

  1. teaching how to rip-off patients and the government///what a bunch of low life

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Capture Billing helps medical practices by reducing their insurance accounts receivable and getting claims paid faster, allowing doctors to focus on providing quality healthcare to their patients without the stress of doing their own medical billing.

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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