Medical billing definitions

WHAT IS MEDICAL BILLING?


Every health care provider that delivers a service receives money for these services. While most of them prefer to collect payment from patients at each office visit, the majority of their fees are processed by filing a claim with the patient’s health insurance provider, managed care organization, or government entities.

Coding for services in healthcare is complicated and therefore trained individuals are preferred. Federal regulations and health insurance policies have contributed to the strong demand for experienced medical coders.

Medical Billing is the practice of submitting claims to Insurance companies or the United States government, specifically Medicare in order to receive payment for services provided to a patient by a doctor.

This process is typically performed in a series of steps where the doctor examines a patient who is sick or provides other services. Depending on the service provided and the examination done, the doctor creates or updates the patient's medical record. This record will record the things that the patient noted to the doctor regarding illnesses or lifestyle. These form the basis for the diagnosis (may be multiple) that is referenced by the doctor as the basis for treatment.

The treatment, along with the diagnosis, and even the time spent with the patient all can be combined to determine the level of service or procedures that were provided to a patient. The doctor then either provides this information to a medical coder (A certified professional coder is known as a CPC.) or may do the coding himself. Next a billing record, either paper (usually a standardized form called an CMS) or electronic, is generated with the information, including various diagnoses identified by using numbers from the current ICD-9 manual.

This billing record is then submitted either to a clearing house that acts as an intermediary for the information (this is typical for electronic records) or directly to the insurance company.

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