What is Medical Billing

What is Medical Billing

Medical billing is the process of filing and managing medical claims to insurance companies or clients. It involves confirming the eligibility of the patient, correctly coding diagnoses and treatments, getting pre-authorizations when needed, filing claims to insurance companies, monitoring the status of the claims, and assisting clients or insurance companies in getting paid for the healthcare services provided. To ensure timely and accurate payment, the procedure requires highly experienced individuals who are committed to tracking and processing payments and tenaciously following up with insurance companies and patients.  

Health Care Billing

Making sure the healthcare professional gets paid for the services they rendered to a patient is the main objective. Medical billing procedures have moved from being paper-based processes with handwritten or typewriter-drafted papers to being an electronic process due to the introduction of different technologies in the healthcare industry. Time, money, and human and administrative errors have all been decreased as a result.

Types of Medical Billing

Medical billing can in a variety of forms, including:

Professional Medical Billing: Doctors, dentists, and chiropractors are examples of healthcare professionals who use this kind of billing to charge for the services they offer to patients.

Hospitals, clinics, and other healthcare facilities bill patients for services rendered using an institutional medical billing system.

Medicare billing: This kind of invoicing is reserved for services rendered to Medicare, a government health insurance program available to anyone who meet certain requirements or are over 65.

Medicaid Billing: This kind of billing is reserved for invoicing services to Medicaid, a combined federal-state health insurance program for low-income and resource-constrained individuals.

Workers' Compensation Billing: This kind of billing is used to charge for medical services given to workers who are covered by workers' compensation insurance after they are hurt at work.

Personal injury billing: This kind of billing is used to charge for medical services rendered to individuals hurt in an accident or other personal injury, with their medical expenses being paid for by the liability insurance of the liable party.

The standards and regulations pertaining to each type of medical billing are distinct, and the billing procedure may change based on the type of billing being utilized. To efficiently manage the billing process and guarantee accurate and timely payment for healthcare services, medical billing specialists and healthcare providers must be aware of the many forms of medical billing.

Many claims that have been rejected for various reasons—such as incomplete or inaccurate data, repeated or late filings, outdated or incorrect CPT or ICD-10 codes, a lack of supporting documentation or previous authorization, among others—can be rectified and appealed. Medical billing is the practice of filing insurance claims to different health insurance payors on behalf of a patient in order to get paid for services provided in a medical facility.

A medical biller collects several kinds of information to be entered into the UB-04 Form (hospital billing) or the CMS 1500 Form (physician billing).

Patient Information

Patient demographic data, including name, address, date of birth, sex, and insurance information, is displayed at the top of the CMS 1500 Form.

Health Information

The patient's medical information, including the date of the injury or illness and the physician's diagnosis, is shown in the middle portion of the CMS 1500 Form.  The code is used to report the patient's diagnosis. 

from Coding Book ICD (International Classification of Diseases).

Provided Services/Fee Information

The CMS 1500 Form's lower portion lists the services the doctor performed together with the related costs for each treatment.  The CPT (Current Procedural Terminology) Coding Book codes are used to report the services provided.

Management of Revenue Cycles

The Medical Biller is accountable for obtaining information, completing the insurance claim form, and sending it to payors. They also have to make sure the claim is correctly processed and the data is correct.  The Medical Biller posts payments made by the insurance payor or the patient to the claim.  After that, any outstanding amounts are either written off, modified, or collected.