Resources
Plain-English guides for practice owners
Billing, credentialing and revenue cycle management explained without the jargon. Every term is defined the first time it appears.
7 min read
What is revenue cycle management? A plain-English guide for practices
Revenue cycle management (RCM) is every step a practice takes to get paid for care, from verifying a patient's coverage before the visit to collecting the final balance. Medical billing is one part of it.
Read the guide6 min read
CAQH credentialing: what it is and how to keep your profile current
CAQH credentialing means keeping a complete, current provider profile in CAQH ProView, the online database many health plans read when they credential a provider. If the profile is incomplete or out of date, the payer cannot approve the provider.
Read the guide6 min read
What is an ERA in medical billing? ERA vs EOB, explained
An ERA, or electronic remittance advice, is the electronic document a payer sends a practice to explain how it processed each claim: what it paid, what it adjusted and what the patient owes. An EOB is the patient-facing version of the same story.
Read the guide6 min read
UB-04 vs CMS-1500: which claim form do you use?
Use the CMS-1500 for professional claims, the services a physician or other provider bills for their own work. Use the UB-04 for institutional claims, the facility charges a hospital or similar facility bills. The electronic versions are the 837P and the 837I.
Read the guide7 min read
How much do medical billing companies charge? Pricing models explained
Medical billing companies usually charge a percentage of collections, a flat monthly fee, a per-claim fee or a mix of these. Percentage pricing is the most common. At Optimus, billing starts at 2.9%* of collections, set by your monthly collections, providers and locations.
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Browse by topic
Guides grouped by the part of the revenue cycle they cover
- 01
Claims and payments
How claims are built, sent and paid: claim forms, remittance advice and the numbers that show whether the cycle is working.
- 02
Credentialing and enrollment
How providers get approved by payers, from CAQH profiles to Medicare enrollment, and why delays cost revenue.
- 03
Choosing and pricing billing help
What billing services cost, how pricing models differ and what to ask before you sign.
Each guide links to the service that handles the task: medical billing, credentialing and pricing.
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