How long do hospitals have to submit claims?

Most insurers require submission within 90-180 days (Medicare: 1 year).

Can hospitals bill patients upfront?

Yes, but comply with the No Surprises Act (provide cost estimates for uninsured/self-pay patients).

What’s the penalty for incorrect billing?

Up to $3k per claim under the False Claims Act.

3811 Ditmars Blvd# 1124, Astoria, NY 11105

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Hospital Medical Billing
A Complete 2025 Guide

Name: Cures Medical Billing Services Company
Address: 3811 Ditmars Blvd# 1124, Astoria, NY 11105, Astoria, NY, 11105, USA
Telephone: +1 (917) 994-9941

What is Hospital Medical Billing?

Hospital medical billing is the systematic process of translating healthcare services into financial claims, submitting them to insurers, and ensuring timely reimbursement. It’s the backbone of a hospital’s revenue cycle, ensuring accurate payment for surgeries, diagnostics, and patient care.

2025 Updates

AI-Driven Claims Scrubbing: Reduces errors before submission.
ICD-11 Compliance: New coding standards effective October 2024.
Telehealth Billing Rules: Expanded coverage for virtual care.

Why Hospital Medical Billing Matters

Financial Stability: 80% of hospital revenue depends on efficient billing.
Regulatory Compliance: Avoid penalties (e.g., HIPAA violations, up to $50k per incident).
Patient Trust: Transparent billing reduces disputes and improves satisfaction.

The Hospital Billing Process 7 Key Steps

Patient Registration: Verify insurance eligibility (use real-time tools like Experian Health).
Service Documentation: Capture diagnoses, treatments, and provider notes.
Medical Coding: Assign ICD-10/11, CPT, and HCPCS codes (e.g., CPT 99213 for outpatient visits).
Claims Submission: File electronically via CMS-1500 or 837P forms.
Payment Posting: Reconcile EOBs (Explanation of Benefits) and ERA (Electronic Remittance Advice).
Denial Management: Appeal rejections within 45 days (top denial reasons: coding errors, missing data).
Patient Billing: Send statements with clear cost breakdowns (30% of hospitals now use payment plans).

Hospital Billing vs. Clinic Billing

Hospital Billing	Clinic Billing
Covers complex services (e.g., surgeries, ER visits)	Focuses on routine care (e.g., checkups, vaccinations)
Uses UB-04 forms	Uses CMS-1500 forms
Longer claim cycles (45-90 days)	Faster payments (14-30 days)

Top 5 Challenges in Hospital Billing (2025)

Claim Denials: 12% of hospital claims are initially denied (upcoding, incomplete documentation).
Coding Complexity: ICD-11 adds 40,000+ new codes.
Prior Authorization Delays: 35% of surgeries face pre-approval hurdles.
Underpaid Claims: 8% of revenue lost to underpayments (audit with RCM tools like Waystar).
Staff Shortages: 30% of hospitals outsource billing to fill gaps.

Comprehensive Healthcare Management Services

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How Technology Transforms Hospital Billing

AI & Automation: Predict denials, auto-fill codes, and flag compliance risks.
Blockchain: Secure patient data sharing between providers/payers.
Cloud-Based RCM: Centralize billing workflows for multi-location hospitals.

Case Study: NYC Hospital reduced denials by 22% using AI-powered claim scrubbing.

Critical Role of Medical Coding

ICD-11 Updates: New codes for climate-related health impacts (e.g., heatstroke).
CPT Modifiers: Use -25 for separate E/M services, and -59 for distinct procedures.
Compliance Tip: Audit 5% of charts monthly to prevent coding fraud.

Key Metrics to Track

Days in A/R: Aim for ≤40 days.
Clean Claim Rate: Target >95%.
Denial Rate: Keep <5%.

FAQs

1. How long do hospitals have to submit claims?
Most insurers require submission within 90-180 days (Medicare: 1 year).
2. Can hospitals bill patients upfront?
Yes, but comply with the No Surprises Act (provide cost estimates for uninsured/self-pay patients).
3. What’s the penalty for incorrect billing?
Up to $3k per claim under the False Claims Act.

States We Serve

Discover Cures Medical Billing Services Across Different States

Florida

New York

Maryland

Colorado

New Jersey

Arizona

Texas

California

Hawaii

Georgia

North Carolina

Washington

Your Success Is Our Success

We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.

At Cures Billing Services, we prioritize collaboration and recognize the uniqueness of each healthcare provider or organization
Maximize your revenue by focusing on growing your practice and let us handle all the back-end billing processes.
We can customize reports to support your practice’s unique requirements

Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.

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