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How to Process Billing and Coding of Medicare Fee-for-Service Claims?

Dec 29

This article aims to educate readers on the basics of billing and coding Medicare FFS claims. This information will help health care providers take control of their medical office's billing and coding process, which will result in more accurate charges being submitted to Medicare and increase profitability for their practices.

What is Medicare?

Medicare is a federal health insurance program for people 65 or older, certain differently abled younger people, and people of all ages who have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant) and amyotrophic lateral sclerosis.

Medicare covers outpatient services, doctor visits, and tests and treatments. The fee-for-service payment system pays doctors based on their time spent doing each service, not on how much care they provide.

The Basics of Billing and Medical Coding

Medicare billing and coding are two critical tasks that must be handled to ensure you receive payment for your work.

Medicare billing is the process of submitting claims to Medicare. A claim is a written request for payment from one party (the provider) on behalf of another party (the patient). Claims can be filed electronically or by paper form, depending on the type of claim being submitted. Coding refers to codifying medical services into an electronic health record system so they can be easily accessed when ordering tests or treatments later. It also helps health care providers keep track of their patient's progress over time and ensures accuracy when billing them later on down the road!

The importance of coding and billing cannot be stressed enough, as they're the foundation for a successful medical practice. If you don't have these two functions down pat, you won't be able to bring in any revenue! Therefore, it is an excellent decision to get the help of top-notch medical coding services.

Medicare Fee-for-Service (FFS) Bill Types

The Medicare fee-for-service (FFS) program has two billing methods, known as the "paper" and "electronic" systems. There are two types of claims.

  • Electronic Claims:  Electronic claims send to the Medicare office on form CMS-1500 Claim Form. Payments made using these methods are referred to as electronic claims.
  • Paper Claims:  Medicare only accepts paper claims in some exceptional cases.


CMS-1500 Claim Form

The CMS-1500 is a claim form used by Medicare providers to bill for services provided on or after January 1, 2015. The form is used when you receive payment directly from Medicare and no longer have to submit claims through your insurance company.

The primary purpose of this form is to electronically transfer information about your care so that it can be processed by the Centers for Medicare & Medicaid Services (CMS). This includes:

  • Patient demographics such as age, sex, and race;
  • Information about who provided each service;
  • Date of service performed;
  • Amount paid for each visit or procedure performed during the period covered by your claim.
  • However, electronic claims submission isn't always straightforward. The process can be pretty complex and time-consuming. That's why it's essential to have a partner with experience helping you in medical billing services

Paper Claims

Paper claims are submitted by providers electronically through their health plan's billing system. They may also be submitted on paper in envelopes mailed directly to the provider's office address or to a third-party such as an insurer or employer who wants to offer them on behalf of their employee/employers. Paper claims may include:

  • Forms the patient has completed.
  • Physicians' notes.
  • Laboratory reports, pathology reports, radiology reports, et.

But does not include other documentation such as physician orders for medication administration purposes.

Electronic Claims Submission

Electronic claims submission is a requirement for Medicare.

Medicare beneficiaries must report all services they receive to their insurance company, which will submit the claim on their behalf. This allows providers to receive payment electronically and eliminates delays associated with paper-based submissions. In addition, electronic claims enable providers to track patient status and bill for services quickly and accurately in advance of the end of the month so that patients don't have to wait weeks after getting care before receiving reimbursement from their insurer or insurance company (or self-pay).

Principles of Coding

Coding is the method of assigning numbers to medical terms. Coding provides a common language to communicate patient information between hospitals, physicians' offices, and other medical facilities. To facilitate research by allowing researchers to collect and analyze data from various sources.

. It's used in several ways:

  • To describe a patient's diagnosis and treatment, which can be billed to insurance companies as part of their fee-for-service (FFS) coverage. This coding system is called ICD-10 or International Classification of Diseases 10th Edition (ICD-10).
  • To bill insurance companies for services offered by physicians and other health care providers, who may also use this method to bill patients directly through their practice charge accounts.

Different Types of Coding Systems for Medicare

Diagnosis Coding

Diagnosis coding assigns a specific diagnosis to a patient using the diagnostic codes. Each diagnosis is coded into specific alphanumeric codes. The ICD 10 CM classification system creates these codes. The diagnosis code indicates the reason for visiting your doctor and determines how much you'll be reimbursed for your visit. It also determines which procedure codes can be billed.

Procedure Coding

Procedure codes are used to identify the specific service provided. They are typically four digits but can be up to nine digits for some procedures.

Procedure codes are not specific to a particular diagnosis or patient; instead, they provide information about what was done during the service provided


Health Insurance Prospective Payment System (HIPPS) codes are the codes that are used to describe the services provided by the healthcare professional. They have 5-digit alphanumeric values and can be used to identify items you purchase, such as diagnostic tests and supplies. You can use these codes on your claim forms when you need to bill Medicare for services rendered by your provider during an office visit, hospital stay, or other visits with your doctor or other healthcare professionals. The complete list of codes of HIPPS can be found on Be sure to check back often, as they are updated every year.


Ultimately, it's important to remember that billing is an art. You have to be creative, and you need to know your audience. If you don't, then there is no way that you can truly understand who they are and what they want from your service or product. So take the time to research what people want before going into medical coding. U control billing is a medical coding and billing company. We provide comprehensive services to help your practice grow and thrive. We know every patient has unique requirements, but you deserve to get paid for the care you give them! That's why we provide top-notch medical coding services at affordable prices.

Our billing services will make your life easier. We take care of the paperwork so you can focus on what matters most: providing quality care. Our team consists of certified medical coders and billers who are highly trained and experienced in all areas of healthcare, including physicians' offices, urgent care centers, and other private practices like yours. We have vast years of experience helping our clients submit timely, accurate, and compliant Medicare claims that get paid quickly by insurance companies.