Frequently Asked Questions

Medical billing is the process of submitting and following up on insurance claims to receive payment for healthcare services. It covers everything from charge entry and claim submission to payment posting, denial management, and patient billing.

Medical coding translates a provider's clinical documentation into standardized codes (ICD-10, CPT, HCPCS). Medical billing uses those codes to create and submit claims to insurance companies and manage the payment process. Both work together as part of the revenue cycle, but they are separate functions with different skill sets.

A complete medical billing service covers patient eligibility verification, charge capture, medical coding, claim scrubbing, claim submission, payment posting, denial management, AR follow-up, patient statement generation, and monthly performance reporting.

A clean claim rate is the percentage of claims that are accepted and paid on the first submission without rejection or denial. The industry average is 75 to 80 percent. GenMediTech maintains a 98 percent first pass clean claim rate, which means faster payments and fewer denials to work.

Outsourcing eliminates the cost of hiring, training, and retaining in-house billing staff. It also reduces expenses related to billing software, compliance training, and denial rework. Most practices save 30 to 40 percent on billing-related operational costs when they outsource to a specialist billing company.

The industry benchmark for average AR days is 30 to 45 days. GenMediTech clients average 30 days in AR. High AR days — above 50 — usually indicate billing process problems that a professional billing team can identify and fix.

Yes. GenMediTech manages patient statement generation and patient balance follow-up as part of the full revenue cycle. Patients receive clear, accurate statements with multiple payment options.

GenMediTech is system-agnostic and works with any EHR or practice management software the practice already uses. There is no need to change systems or migrate data when onboarding with GenMediTech.

GenMediTech completes onboarding in 48 hours. Billing begins in the first week with no interruption to the practice's existing workflow.

Revenue cycle management (RCM) is the complete financial process of a healthcare practice — from patient registration and insurance verification through billing, collections, and reporting. It covers every step between a patient visit and a collected payment.

Medical billing refers specifically to claim submission and follow-up. Revenue cycle management is broader — it includes front-end processes like eligibility verification and prior authorization, middle functions like coding and claim submission, and back-end functions like denial management, AR recovery, and financial reporting.

GenMediTech provides a full revenue cycle including eligibility verification, prior authorization, medical coding, claim scrubbing, clean claim submission, payment posting, denial management, AR follow-up, patient billing, credentialing, and monthly performance reporting.

A well-managed revenue cycle means claims go out clean, get paid faster, and denials get worked quickly. Practices with optimized RCM processes collect 15 to 30 percent more revenue than those with reactive billing workflows, and they reduce days in AR significantly.

Front-end RCM covers the steps that happen before a claim is submitted — patient registration, insurance eligibility verification, benefits confirmation, prior authorization, and co-pay collection. Front-end errors are the leading cause of claim denials, which is why GenMediTech starts the revenue cycle with real-time eligibility checks on every patient before every appointment.

The most common RCM failures are eligibility verification gaps, missing prior authorizations, coding errors, delayed claim submission, no systematic denial follow-up, and AR aging without action. GenMediTech addresses all of these as part of a managed revenue cycle, not as separate issues.

Provider credentialing is the process insurance companies use to verify a provider's education, training, licensure, work history, and malpractice record before allowing that provider to bill under their network. Without completed credentialing, claims submitted by that provider will be denied.

Most credentialing takes 90 to 120 days. Medicare through PECOS typically takes 30 to 90 days. Commercial payers typically take 90 to 120 days. Medicaid timelines vary by state, ranging from 45 to 120 days. Incomplete applications and expired CAQH profiles are the most common reasons credentialing takes longer than necessary.

Credentialing requires a completed application, proof of education and residency, an active state medical license, board certifications, a detailed work history with no unexplained gaps, current malpractice insurance, DEA registration if applicable, professional references, government-issued ID, and authorization for a background check.

CAQH ProView is a centralized provider database that most commercial payers pull from instead of requiring a separate application. If the CAQH profile is incomplete or the attestation is expired, every payer connected to that profile stalls simultaneously. CAQH must be fully complete, currently attested, and authorized for each specific payer before credentialing can move forward.

Credentialing is the verification of a provider's qualifications. Enrollment is the process of signing a payer contract and being loaded into the payer's billing system. A provider can be credentialed and still not be enrolled. The billing effective date — the date from which the payer will pay claims — only starts after enrollment is complete and confirmed in writing.

Yes. GenMediTech manages re-credentialing cycles for existing providers, typically required every 36 months by NCQA-aligned payers. We initiate re-credentialing 90 to 120 days before expiration to prevent any lapse in network status.

A provider can see patients before credentialing finishes, but the practice cannot bill insurance for those visits until the provider is credentialed and the payer has set a billing effective date. Without that effective date confirmed, claims will be denied even if the provider is fully credentialed.

GenMediTech offers five AI-powered solutions: AI Medical Scribe Solution, AI Denials Management, AI Medical Coding Solution, AI Virtual Assistant, and AI-Powered Physician Assistant. Each one addresses a specific revenue or efficiency problem in the healthcare workflow.

GenMediTech's AI Denials Management platform tracks denial patterns across all claims by denial reason, payer, provider, and CPT code. When a pattern appears — the same denial code from the same payer on the same procedure — the system identifies the root cause so it gets fixed upstream, not just on individual claims.

An AI Medical Scribe captures and transcribes provider-patient conversations in real time, generating clinical documentation automatically. This reduces the time physicians spend on documentation and improves note accuracy, which directly supports more accurate medical coding and fewer medical necessity denials.

GenMediTech's AI Medical Coding Solution reviews clinical documentation and suggests the correct ICD-10 and CPT codes before the claim is submitted. It flags diagnosis-to-procedure mismatches, missing modifiers, and bundling conflicts — catching coding errors that cause denials before the claim leaves the practice.

Yes. AI tools are integrated into GenMediTech's standard billing workflow, not offered as separate add-on products. Every critical care, ENT, cardiology, and specialty claim benefits from AI-assisted coding review and denial pattern analysis as part of the standard service.

Yes. Each state has its own Medicaid program with different filing deadlines, documentation requirements, managed care rules, and payer policies. Commercial payer behavior also varies by state. GenMediTech's billing team understands the specific rules for each state's Medicaid program and dominant commercial payers.

Timely filing limits are the deadlines payers set for receiving claims after the date of service. Medicare allows 12 months. State Medicaid programs range from 90 days to 12 months depending on the state. Commercial payers typically allow 90 to 180 days. Missing a timely filing deadline results in a permanent denial regardless of whether the claim was otherwise correct.

Yes. GenMediTech has state-specific billing knowledge for all 50 US states, including each state's Medicaid timely filing window, MCO-specific requirements, and documentation standards that differ from the federal FFS program.

Yes. GenMediTech operates under full HIPAA compliance. All patient data is handled with secure systems, encryption, and access controls limited to authorized personnel only. GenMediTech's billing processes are designed to protect protected health information (PHI) at every step.

GenMediTech uses secure encrypted data transmission, restricted system access, and strict internal protocols for handling protected health information. All staff members receive regular HIPAA training. No patient data is shared with unauthorized third parties under any circumstances.

GenMediTech's coding and billing teams receive continuous training on CPT, ICD-10, HCPCS, and payer policy updates. CMS issues annual code updates and payers revise their coverage policies throughout the year, GenMediTech applies these updates to client billing workflows as soon as they take effect.

GenMediTech's billing audit team identifies compliance risks before they become external audit triggers. If a compliance issue is identified, GenMediTech works with the practice to correct the billing process, document the correction, and implement safeguards to prevent recurrence.