How Does Medical Billing and Coding Work Behind the Scenes?

What this video covers

This video traces a claim from patient check-in to final payment, showing what coders, billers, and payers each do along the way. It explains eligibility checks, charge capture, claim scrubbing, adjudication, denials, and posting in plain language. It is useful for practice owners, new administrators, and clinicians who want to understand where their revenue actually comes from and where it leaks.

• Coding drives payment. ICD-10 and CPT selections determine what a payer will reimburse, so documentation quality directly controls how much revenue a practice keeps.
• Scrubbing prevents rejections. Claims checked for errors before submission clear payers faster, and the industry target is a clean claim rate above 95%.
• Denials need follow-up. Denial rates commonly run 5 to 10%, and unworked denials become write-offs unless someone corrects and resubmits them quickly.
• A/R measures health. Days in accounts receivable under 40 signals a healthy cycle, while rising A/R means claims are stalling somewhere in the pipeline.

Staffingly staffs every stage of this pipeline with dedicated remote billers and coders working under a signed BAA and SOC 2 Type II controls. Practices among our 800+ US healthcare provider clients cut staffing costs by up to 70%, starting with a 2-Week Risk-Free Pilot. Learn more about Staffingly’s Revenue Cycle Management services.