Patient care is the focus for any practice today, but with the growing complexity of healthcare reimbursement and rapid reduction of staff working in healthcare systems, third-party medical billing companies are impetus to providers. It’s estimated that providers on average lose 10% to 15% of their revenue during the medical billing process. A myriad of reasons responsible for the revenue loss: inadequate and inaccurate coding, mistakes in billing practices, and improperly updated fee schedules

An outsourced medical billing company comes with experience and resources to ensure long-term sustained medical billing service. The resource and experience eliminate the reimbursement denials, satisfy several of the regulatory requirements such as HIPAA and eliminate the coding errors.


Enter the patient's diagnostic and treatment details in Electronic Health Record (EHR)?

In this step, providers are tasked with gathering all the information required by payers to process the payment. EHR or Electronic Health Record contains patients' medical history and automates the workflow for the providers. Document the complete diagnosis examination results and treatment plans for optimal reimbursement.


Apply the Medical Codes in the EHR

Certified Medical Coders from Legion enter the appropriate medical codes for reimbursement in the patient's EHR. The coding helps the payer to understand the narrative description given by providers into specific terms of reimbursement.

  • ICD-10 (Tenth revision of the International Classification of Diseases codes) was created by U.S. NCHS (National Center for Health Statistics). ICD coding helps describe the condition or diagnosis of the patients.
  • CPT Codes was created by American Medical Association (AMA) is used by doctors and healthcare providers to describe the treatment and diagnostic services provided for that diagnosis.
  • Value-based reimbursement models: Value-based reimbursement models deliver reimbursement based on the quality of care and not on the volume of care. There are currently four types of Value-Based Reimbursements Models: Bundles, shared savings, shared risks, and global capitation.


Claims Submission

Before the claim is submitted, it needs to be checked for any errors. Legion Medical Billing service providers can work in tandem to deliver maximum reimbursement. For the first transaction, the claim for all the services provided by the provider is known as X12-837 or ANSI-837. This document contains large amount of patient data, the interaction between patient and provider, and references info about the provider. The payer responds with X12-997, this is a simple acknowledgment with regards to claim submission. X12-835 transaction describes the items that will be paid or are denied. If paid, the amount is mentioned, and if denied, the reason.



After the payment has been made, a provider receives Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).

Legion has an experienced team of Coders, Billers and AR callers, who regularly get trained to provide maximum reimbursement for any specialty and provider.

100% charge captured and billed.

95% accuracy for all providers.

Speciality focussed coders.

Time-bound turnaround time for all denials and claim submissions.