Understand the Medical Billing Process in Depth

Medical Billing is a detailed process undertaken by professional medical billers which aids the doctors, hospitals and medical institutions to receive the payments and claims from insurance industries efficiently. This field plays a pivotal role in the healthcare industry for its smooth operation. Undertaking the medical billing procedures correctly and efficiently requires in depth knowledge of the field along with good knowledge of insurance industry as well.

The Medical Billing Process in Brief:

Whenever a patient visits any healthcare provider and takes their services, the healthcare provider’s services are entitled to be reimbursed by the respective insurance firm. In order to claim the service money, the medical biller comes in picture to check the patients’ bills and reports and establish the treatment undertaken by the patient. The next step they are supposed to take is to verify that the patient is properly insured under the insurance coverage and note down the name and other details of the patient and the insurance company and proceed with the legalities of filing the insurance claims and get the money reimbursed.

Why do the Doctors Need Medical Billers?

Medical billing is a detailed process which includes checking and re-checking patients’ bill details, extensive processing for collecting claims, collection of receivables, make appropriate appeals for denied claims and maintaining reminder for past due accounts and much more. Undertaking all these procedures along with routine medical check-ups and hectic schedules is quite impossible for the doctors due to which it becomes inevitable to hire a medical billing specialist.

What it takes to be an Expert Medical Biller:

The medical billing art is explored best when the level services rendered to the patient is decided by the medical biller based on history and background provided by the patient and correctly gauging the services rendered to the patient. Only after deciding the level of service, it is transferred into five digit code based on Current Procedural Terminology (CPT). The oral diagnosis is transferred into another numeric code using the ICD-9-CM database. This alphanumeric code is very important in determining the claim process amount by the insurance companies. After this the medical biller has to file the claim by filling the form CMS-1500 to the respective insurance company. Depending on the claim analysis done in the insurance company either the claim will be approved or rejected. If it is approved the medical biller has to fill the Assignment of Benefits (AOB) form which allows the claim to be transferred directly to the provider rather than the insured. If the claim is rejected, the medical biller will have to re-apply the claim after making necessary changes and submit the form of Explanation of Benefits (EOB). This process of re-applying for the claim may continue for long and it might become tricky at times for the medical biller to get the claim amount from the insurance company.

Importance of Medical Billing and Coding:

With medical coding and billing standards becoming stringent day by day it is becoming more necessary for the medical practitioners to hire medical billing experts. Rendering medical billing services from home is also a bright career option for work from home lovers. According to a survey by American Hospital Association in 2007-08, 18% of medical billing and coding employments seats remain vacant due to lack of professional medical billing specialists. By firm commitment to excellence and hard work professional medical billers can have a promising career ahead.

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