What is Medical Billing?
By: RyanC | Posted: 22nd February 2011
Medical billing can be a very complex procedure which includes billing and collecting fees from patients that have received medical and heathcare services. In order to succeed in this kind of profession, you will need to have 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.
Traditionally doctors graduate from medical school with the expectation that they will practice medicine and deliver patient care. Running a business, however, is not part of their premise. To them, running a business is for business professionals. However, the catch twenty-two is that medical practices ARE a business and need to be properly managed and run as such. Running a medical office includes certain administrative procedures, and getting paid for services is part of any business. Physicians don't have to do everything themselves. Running a medical office business requires a full team of medical office staff with each one playing a vital role to keep the operation going.
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.
Medical billers not only review charge slips and track payments, they also analyze records to produce customized reports that show profitability or areas in need of improvement. Such reports are critical when decisions need to be made on renewing and negotiating contracts. They also advise physicians of fee structure changes, new coding practices, and ways to improve the office’s bottom line. Most medical billers also handle the offices dictation transcription. This saves the medical office money and allo9ws the healthcare providers to comply with the strict HCFA rules, which mandate clarity of all Medicare claims.
Medical billers use the HCFA-1500 form to submit health insurance claims to insurance carriers. They must know appropriate responses to a variety of billing and legal situations. Bill collection, release of patient information/records, patient confidentiality rights, subpoenas, workers’ compensation rules, and Medicare regulations for reimbursement are complicated areas and must be handled competently and with care.
To get paid an Assignment of Benefits (AOB) is used, which is an authorization directing the insurer to make payment directly to the provider of benefits, rather than to the insured. The insurance carrier however, is the one who determines whether benefits are payable.This article is free for republishing
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Tags: running a business, insurance coverage, health insurance, medical bills, business professionals, medical practices, insurance companies, medical billers, medical biller, collection agencies, health care plans, moneys, health insurance company, compani, medical specialties, cpt codes