Medical billing by definition is a process by which doctors and hospitals are getting paid from health insurance companies. The process involves resolution of disputes and following up on claims that have been delayed or rejected. Medical billing is a complex series of procedures which require skill and knowledge of processes involved. Many hospitals have entire departments that work on medical billing processes. Medical billing is a vital process for the sustenance of any health care organization. The health industry is structured in such a way that, health service providers need to get their payments processed by the insurance companies.
Need For Billing Specialists
Due to the complex nature of the medical billing process, the professionals who are involved in such processes and operations are called medical billing specialists. Indeed, there are dedicated professionals educated in the billing process and are trained to handle the medical billing transactions. We are aware of the detailed records kept of tests conducted and procedures and other examinations that are performed on patients. Diagnoses documents are also noted and maintained by doctor’s offices as well as by patients. These comprise of the medical records which are submitted by the patients to claim insurance and are verified by the insurance company by comparing the records maintained by the medical facilities. In such a manner the medical billing cycle begins.
Responsibilities They Bear
The medical billing specialists not only handle such transactions, they are aware of the coding procedures as well. Every service or procedure is provided an alphanumeric code as per a standardized system in US. The medical billing specialists need to be aware of the codes as per the Current Procedural Terminology manual. Here the diagnoses are coded as per the International Classification of Diseases manual. The medical billing specialists also need to know the use of electronic medical billing programs. These assign the codes to medical records as they are filed. The code assignment happens automatically by such programs. However the medical billing specialists need to check the bills manually for ensuring accuracy and that no mistakes have occurred.
Process of Reviewing Bills by Insurance Companies
After the coding process is finalized, the bills are sent across to the medical insurance company. Bills might be sent by fax or by electronic mail. Insurance companies will review the information received and check the coverage of the patient and whether the treatment was appropriate as per the diagnosis submitted by the doctor. If the treatment is considered to be standard and customary, the bill is approved for payment. The payment is determined by the allowed amount as per the existing insurance policy of the patient and whether the doctor falls on the list of network providers. The insurance company will send across the payment electronically or send a notice of denial if the claim does not meet the standards set for payment.
Online Billing Programs
There are online medical billing programs as well. These are web enabled programs which can be accessed by different healthcare providers to standardize the billing process in their organization.