76. Medical Billing

Medical billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government-owned. The billing process is an interaction between a healthcare provider and the insurance company (payer). The interaction begins with the office visit: A doctor or their staff will typically create or update the patient's medical record. This record contains a summary of treatment and demographic information related to the patient. Upon the first visit, the provider will usually give the patient one or more diagnoses in order to better coordinate and streamline his/her care.

In the absence of a definitive diagnosis, the reason for the visit will be cited for the purpose of claims filing. The patient record contains highly personal information: the nature of illness, examination details, medication lists, diagnoses, and suggested treatment. When a patient is seen by a doctor or provider, a claim is coded, billed and processed. It is submitted to an insurance company or federal government agency. Medical billers are good at detail and are well-organized. They may have knowledge or education in data entry, bookkeeping, technical or computer knowledge and work well with people. Although most medical billers work in back offices and don't have a lot of contact with the public.

Medical billing is a complex procedure of billing and collecting professional fees for medical and healthcare services provided to patients. Doing it right requires a broad range of knowledge and understanding of the medical billing process and Health Insurance Company rules. When a physician or healthcare provider renders medical services to a patient they are entitled to be reimbursed. Collecting these moneys due is the medical biller's job. After each healthcare appointment the medical biller reviews the super bill or encounter forms attached to the patient's record to establish which services were provided. Next they re-check the patient's insurance coverage and note the name of the health insurance company. Then they prepare proper invoices and submit the claim.

Medical billers are the ones who organize medical bills and statements, comb through them for errors, negotiate with collection agencies, answer patient's questions about their health-care plans and the office's billing routine, and spend hours on the phone with insurance companies on a client's behalf. Think about the large number of medical specialties, countless medical conditions and diseases, plethora of CPT codes and Medicare rules, the multitude of health insurance companies (payers), and billions of patients everywhere!!!