Medical billing is a bill pay method within the U.S. healthcare system. The process typically involves a healthcare professional submitting claim forms, after which, they follow-up on, and appeal certain claims with individual health insurance providers to get payment for medical services rendered; including tests, treatments, and various procedures. Medical Billing and coding involve the collection of payment from healthcare providers. There are generally two primary pillars, i.e., health insurance providers and hospitals or clinics. The first biller collects the payments from healthcare providers, and the second biller manages the flow of medical bills from providers to healthcare facilities through the revenue cycle.
Medical billing process automation software is utilized by most healthcare providers today in order to reduce the number of errors and to improve the efficiency of the billing process. This software aids in maintaining proper patient account balances, patient record management, eliminates duplicate diagnosis and treatment codes, controls billing errors, reduces medical cost containment, and expedites the healthcare provider payment cycle. This software may be used to:
Many medical billers and coders work at home, on the internet, or part time. In addition, there are currently thousands of medical billers and coders that have been trained on the job through various training programs. Some of the programs include; Certified Professional Coder (CPC), Medical Office Revenue Cycle Management (MRTC), Medical Billing and Coding Specialist (MBCS), and Medical Billing and Coding Associate (MBAC). Medical Billing and Coding Associate programs are gaining popularity due to the high demand for these types of professionals.
Medical billing and coding technicians are trained to perform a set number of duties. Medical billers and coders generally work directly with patients and physicians. Medical billers ensure that the correct charges for services are received by the payer. They also verify the appropriateness of codes for billing, insurance, and procedural codes. Medical coders usually do not deal with patients directly.
Medical billers complete claims forms, prepare invoices, forward them to healthcare providers, and maintain client contacts. Medical billing is an administrative function carried out by healthcare providers in which they submit claims to health insurance companies for reimbursement based on agreed upon rates. In order to be licensed in this field, the healthcare provider must complete an accredited degree program and pass at least one year of approved clinical experience. To become certified, you must successfully pass the Medical Billing and Coding Specialist (MBCS) exam.
Medical claims processing companies provide a comprehensive service to healthcare providers. These companies are responsible for collections, secure patient records, and responding to payments from insurance carriers and payers. Medical billers help healthcare professionals in creating and following a correct revenue cycle management system. To reduce healthcare expenses, the revenue cycle management system recommends that a patient pay only for services received and not for "allowable" care. It also helps a healthcare provider avoid adjusting costs for services received or provided, under the influence of emotions and sentiment, for fear of receiving notice of a denied claim.
