Medical billing is a process that generates healthcare claims for insurance companies to obtain payment for services rendered by medical providers and provider organizations. The medical biller will follow the claim after converting a healthcare service to a billing claim in order to ensure that the organization receives payment for work performed by the provider. A medical biller who is well-versed in the field can maximize revenue for a physician practice or healthcare organization.
What Is the Difference Between Medical Billing and Medical Coding?
The processes of medical coding and billing differ but are related. Both are essential to the healthcare industry, as they are both involved in reporting diagnoses, procedures, and supplies to commercial payers and federal payers such as Aetna or Medicare.
Both medical coders, as well as billers, work with clinical staff. They must be familiar with medical terms and anatomy in order to read physician notes and surgical reports. Sometimes medical coders are involved in the billing process, and they may even code for billing firms. It’s not unusual for a person to be both a medical coder as well as a medical biller in small physician practices. While billing and coding may not be the same thing, they are both equally important parts of the revenue cycle in healthcare.
What Do Medical Coders Actually Do?
A medical chart is created every time a patient visits a clinician to receive medical treatment or for an evaluation. Medical coders examine the chart to extract information that can be billed and then convert it into standard codes.
The payer can find out what services the healthcare provider provides by using procedure codes, such as CPT(r), ICD-10 PCS, or HCPCS Level 2. Diagnose codes reported using ICD-10 CM code set to tell the payer what services the patient received.
Medical billing and coding are now combined in the standard codes used by medical billers to create insurance claims for patients and generate bills.
The medical billing cycle does not begin until medical coding is complete. It continues until all reimbursements are received by the healthcare provider or physician.
Medical billers coordinate between patients, healthcare providers, and payers (also known by the term payers) in order to obtain reimbursement for healthcare services. Billers collect the necessary information first. Billers collect information about the patient, including demographics, medical histories, insurance coverage, and services or procedures received.
Billers must review the medical records of patients and their insurance policies to confirm coverage. The billers then create medical claims, verify their accuracy, and submit them to the payers. The claims are then returned to the billers once the payers have approved them.
Billers will prepare the bill for the patient at this time, or even before the patient sees the doctor. Billers subtract the insurance coverage from the price of the service or procedure, add copays and deductibles to the total, and then add any outstanding balances. When necessary, invoices are sent out to the patients, and payments are posted. The medical biller’s day is filled with many other activities.
Medical Billing Is a Process That Requires a Lot of Documentation
The medical billing cycle is made up of many steps, which can take anywhere between a few hours and several months. Accurate billing and timely follow-ups are the No. 1 priorities. In most states, insurance companies are required to pay claims in 30 or 45 days. In contrast, payers set deadlines for filing claims that if missed nullify coverage. The late claim will be denied without the option of appeal and the organization will forfeit reimbursement.
Medical billers who are able to master their billing role can be very valuable. Errors at any point in the billing cycle could prove costly, both in terms of revenue as well as administrative workload. The financial health of provider organizations such as hospitals, healthcare systems surgery centers, and physician practices, depends on front-end and rear-end billing staff.
This post was written by Physicians Choice Medical Billing, LLC. Physicians Choice Medical Billing, LLC has been providing exceptional, and comprehensive Full-Service Practice Management including medical billing expert Florida, coding, revenue cycle management, credentialing and consulting services to our clients. Whether you are a new startup or an established medical group, PC has the experience and dedication to make your practice a financial success. The staff bring multiple years of experience and dedication. Fingerprinting in Tampa and Fingerprinting in St Pete with Physicians Choice provides the highest quality, professional digital Live Scan fingerprints in a comfortable professional office atmosphere. Physicians Choice offers both individual and corporate account service.