How Medical Billing Works

Medical billing is a process that involves three parties. It includes the patient, the health care provider, and the insurance company. It is done so as to ensure accountability and transparency among the three parties. A medical billing company is responsible for the process. The company acts as a link between the patient and the health care provider. It also has the responsibility to collect the required payment from the health insurer. Accurate billing is important so as to have the correct payment. There should be no overcharge or undercharge on the patient. Medical billing is explained in the steps below.

1. Checking in the patient It involves recording information that relates to the patient. The demographic information such as name, address, date of birth and purpose of the visit is recorded. The insurance details are also collected from the patient particularly the name of the insurance company. The patient’s policy number is also entered at this step. All the information will be used for reference purposes during payment.

2. Verifying the insurance information The medical billing company will then have to make sure that the patient is eligible for insurance. Patients will be asked to check from their insurer if the details have changed. Some services by the health provider might not be covered by insurance. It is necessary for the patient to confirm which services are covered. This will ease the process of billing.

3. Coding This requires communicating with the insurance provider what the patient is being treated for. The treatment method is also stipulated to the health insurer. Here, the correct codes are used to avoid confusion and errors. The Current Procedural Terminology (CPT) codes and Healthcare Common Procedural Coding System (HCPCS) codes are properly used to show the illness of the patient and the treatment procedures performed.

4. Entry of charges It entails entering the information on the charges for the medical services the patient received. Medical codes pertaining to the treatment and procedures are linked here. Linking them makes it a simple task at the end when there is a need to refer. It creates an easy file to look at which has been synchronized.

5. Submitting claims After linking all the information about the charges of services offered, it is submitted to the health insurer. Diagnoses and methods of treatment should match the bill. Different insurance companies have their own ways on how and when to submit a claim. The medical billers should, therefore, have this information in mind so that it will not take long.

6. Posting the payments At this point, it means that the health insurer has agreed to process payments. This will happen if the codes were correctly submitted. After verification, the insurer will release the payments. The patient’s bill will reflect a zero amount if it has been fully settled. It is such a relief when the patient gets a notification that their medical bill has been paid. The medical billing process ends at this point with the three parties fully satisfied.

Conclusion Medical billers ought to be timely and accurate in their submissions. Proper coding means shorter payments without disputes. For a medical bill to go through well, prior knowledge of submitting the claims is also necessary. The patient plays a role in ensuring they know the details of their insurance.