Medical insurance billing

The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.

There are more than 500,000 health care professionals in the United States who need to bill for their services. Most health care providers employ billing staff in their own office or are part of a larger organization like a group practice or a hospital that processes their claims and helps manage their finances. Some health care providers choose to outsource their claim processing and accounts receivable management, and qualified billing services have the opportunity to provide these services.

What is a billing center/ house?

Billing center is a centralized office that handles the provider/ hospital’s billing
activities. It could be a part of the hospital network or can be an outsourced
organization. Billing houses relieve the burden of maintaining hospital bills and
accounts and assist in claims submission process. Billing houses can handle more than one hospital/ provider at a time as they are independent organization.

Parties in Medical Billing

There are three parties in the Medical Billing Process. The PHYSICIAN, The
INSURANCE COMPANY and The PATIENT. The Physician in order to attain his
objective should comply with the rules and regulations outlined by various insurance companies in submitting claims and at the same time should not penalize the patient.

Medical Billing Forms

HCFA 1500 – Most commonly used claim form for billing services that are rendered at an office location. This form is used only to bill for Professional services. There are 33 fields in this form.

In this form we fill the charge details - CPT code the standardized code format for the service rendered, Type of service, Place of service, modifier – is added along with the CPT code which gives an additional value to the code, diagnosis code – the part of the body where the service was rendered, units & billed amount.

UB 92 - This form is used for billing services rendered at a facility or a hospital; it is used only for billing Technical services. There are 83 fields in this form.


The major types of health insurance coverage fall neatly into two  categories:Federal and commercial insurance.

The process of submitting the above forms to Medical insurance and get paid process called as Medical insurance billing.

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