Medical Billing

Medical billing is the process of translating a health care service into a billing claim. It involves the submission of the following up claims of patients with health insurance companies to ensure the health care providers receive reimbursement for their health care services.

The process of medical billing consists of the following activities;

  1. Analyze and consider each individual’s responsibility for payment, as they may vary for each patient.
  2. Estimate and analyze insurance coverage and medical charges, to use the information as an insight for accurate preparation of billing forms.
  3. Accumulate accurate payments from health insurance companies or individual patients.

This process is initiated when a patient schedules an appointment with the health care provider. The receptionist handles preregistration and provides an appointment schedule. If it is the first visit of the patient then the front office prepares the information for the patient’s visit. The information includes; name, address, birth date of the patient and reason for the appointment with the physician. The front office must also capture information regarding the health insurance of the patient, including the name of the insurance provider, and patient’s policy number. All of this information is used to set up a file on the patient, which can be used as a benchmark for the medical billing process.

Medical billing and coding are the procedures that are used to make sure the streamlined working of medical office revenue cycles.

Medical Coder

The main concern of a medical coder is to evaluate clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems.

Medical billing

The medical Billers use the medical codes as an insight into the process and follow up on claims that are sent to the health insurance companies for reimbursement of services provided by a healthcare provider.

The medical coder may also perform the responsibilities of the medical biller or different individuals may also work to ensure the proper payment process.

The demand for healthcare services is projected to increase substantially proportional to the ages of the US population. Therefore, many healthcare organizations are adapting to electronic medical records (EMRs) and will be continually challenged to stay updated with healthcare advancements.

Work Environment

Medical billing and coding professionals work in a wide range of health care facilities, including:

  • Physicians’ offices
  • Hospitals
  • Medical billing services
  • Emergency rooms
  • Ambulatory centers
  • Insurance companie­­­­­­­­­­s

Certification of medical billers

Certified Professional Biller (CPB™):

The Certified Professional Biller (CPB™ certification) performs medical billing process with the technical acquaintance and expertise to maintain all aspects of the revenue cycle. Without deep knowledge and skill in the medical billing profession and the unique understanding of payer requirements, reimbursement of the claims could result in denied, delayed, or incomplete.

Certified Professional Coder certification (CPC®)

The Certified Professional Coder certification (CPC®), is the established standard for medical coding in physician’s office settings. CPC’s have validated authority of all medical code sets, evaluation and collection management principles, surgical coding, and adherence to documentation and medical coding guidelines through laborious examination and experience.

Certified Professional Biller’s have proven expertise to submit claims for health care providers in accordance with government regulations and private payer policies, follow-up on claim statuses, perseverance of claim denials, submission of appeals, posting of payments and adjustments along with collection management.