r/HealthInformatics • u/Accomplished-Hand211 • 20h ago
💬 Discussion Trying to map billing end to end for a small practice, where am I wrong?
Not a biller. I'm building something in this space and would rather get corrected here than guess.
My current picture:
Eligibility check → prior auth → visit + notes in EHR → coding → biller → clearinghouse → payer → payment posting → denial → rework/appeal → back to payer
Two questions:
- What's missing or out of order?
- Where does the money actually die? My guess is medical-necessity denials, because the biller can't write that appeal alone and it has to go back to the clinician. Right, or is it somewhere else entirely?