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It 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.
Medical billing is a vast term which includes the task of submitting claims to insurance companies or government authorities so that the insured can receive payment for services give by a hospital or a general health care provider.
When we take any medical insurance, we need to be reimbursed for our medical expenses from the insurance company. The group of people helping us to make claims and getting our money back into our pockets are called Medical billers.
The process begins the moment you reach the office. The physician makes the record of the patient according to various tests. It is the duty of the physician to provide all the information related to the treatment to the billing specialist.
From this, a billing record is prepared. It can either be on a standardized form called an HCFA or electronic. This form includes the various diagnoses identified by numbers from the current ICD-9 manual.
After the claim has been prepared, it has to be submitted to a clearinghouse (if the bill is electronically generated). This acts as an intermediary for the information. It can also be directly submitted to the company.
Now, the attending physician and the insurance company will negotiate the amount of money that the insurance firm shall pay. It is not necessary that the insurance company will cover the whole expense.
The amount that the insurance company agrees to pay is called allowable. The calculation of the reimbursed amount is a long process and is generally done by the medical biller only.
This process has become very advanced these days and a number of medical billing software are also available in the market.
Recently, the HIPAA act was passes in the United States due to which medical billers had to redesign their software to become compliant with this new act.
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