The medical billing process today is used by doctors and treating physicians to obtain payment for their services. The payments are received from insurance companies that work in the health industry. This process is very important to the medical industry, as doctors rely on this service to receive their income. A medical biller can work for hospitals, private care providers, and even as a home based business. Working in the medical billing field is, in most cases, a rewarding career with flexibility and opportunity for growth.
The medical billing process does not start with the medical billing professional. First, a patient must visit a doctor or hospital for treatment. When a patient receives a diagnosis, that information goes into that patient’s medical records.
Any treatments, medications, surgeries, and procedures are filed electronically as well into the patients file. Every service the patient received carries a price tag with it. Often times, the patient may not see this bill, as they have medical insurance to cover the cost of their medical bills. The hospital or doctor’s office will take note of any insurance the patient may have, and from there hand all the information over to the medical billing personal.
Upon receiving all of the patient and doctor correspondence, the medical billing professional will start their work. The insurance company will not recognize medical terms as they are transcribed by the hospital or doctor directly. The medical biller will then put the medical terms in what is known as “codes”. This part of the process is best symbolized by the word translating. Once the medical biller has translated the notes into different terms, the file is now ready for the eyes of the appropriate insurance company.
A common code system may look like this:
Code: A08.2 – Viral Infection (Adenoviral Enteritis)
Code: A08.3 – Viral Infection (Other Viral Enteritis)
Code: 001.0 – 139.8 – Infectious and Parasitic Diseases
Code: 800.00 – 999.9 – Injury and Poisoning
While these codes look like nothing to the untrained eye, insurance companies will receive the information in a format they can understand, and proceed to start the claims process for the physician.
Medical claims filed with insurance companies allow the doctor to be one step closer to receiving payment for their services. Once a coded medical claim is sent to the insurance company of the patient, the insurance representative then takes a closer look at it for accuracy.
What the insurance representative is looking for is to make sure the services and treatments that were rendered are appropriate and necessary for the patient, according to the doctor’s diagnosis.
The claim would be negotiable and under scrutiny, if the treatments rendered to the patient do not line up with the diagnosis, or seem to not fit the prognosis. It is likely this will never happen, however the insurance company is responsible for making sure all procedures and treatments were needed for that patient. In the event that there was an error made on the medical claim, the insurance representative will refuse the claim and return it for revision. If the claim is correct, the insurance company will approve it. Any cost the insurance does not cover will roll over to the patient.