Medical billing, in simple terms, is the process of filing the correct claim forms with insurance companies, governmental agencies or private organizations in order for a physician or medical practice to be paid for services rendered. It is a vital role in a physician’s office, small practice, health clinic or in a hospital setting, that allows the physician to concentrate on actually providing healthcare services instead of running a business.
Medical billing includes billing for medical services rendered as well as for administered medications, doctors’ consultations and equipment and supplies used in a particular case. It also involves collecting the payments sent by the insurance companies, government agencies or private organizations and posting them.
Communication is another big part of medical billing, since medical billers are also responsible for following up on the claims they submit, requesting information for unanswered claims, responding to requests for information from other sources about the claim, and communicating with patients and insurance companies, government agencies and private organizations when there is a question about a claim, such as when a claim is denied or delayed. Patient communication also includes sending statements to the patients, as well as reporting delinquent accounts to the correct debt collection agency.
Additionally, medical billing includes reviewing bills and statements to make sure that the right coding is used and that all work being billed can be supported by actual proof that the physician performed the work being billed, that the equipment and supplies were actually used or that the medication was actually administered. Though a medical biller does not code, she does receive coded bills and forms that she must then review for accuracy before submitting.
Medical billing also involves submitting appeals when a claim is denied or when the payment amount differs from the bill amount due to a coding or other error. This requires organization, another of a medical biller’s responsibilities, as well as patience and research skills. Organization is required, since medical billing includes organizing all bills and statements and keeping track of many different claims at once. Patience is also required since some claims might generate hours of phone communications with the patient, service providers, insurance companies, government agencies or private organizations involved. Research skills are necessary to be able to locate the proof for every service rendered or equipment, supply and medication used.
Medical billers must be quite knowledgeable since they need to be familiar with all the different types of codes as well as the requirements and regulations of the different insurance companies, government agencies and private organizations, since a small error in this can cause a physician or clinic to lose money and might even cost a patient more money if the insurance company refuses to pay.