Medical Billing is the process of getting a provider paid for their services. This is payment from the insurance carrier and the patient for uncovered or deductible charges.
A good medical billing specialist knows how to get their provider paid promptly for the services they perform.
What the billing specialist does is not easily automated. Much of their task is interpreting physician notes and records, verifying and correcting patient and insurance information, verifying correct coding, etc.
It’s pulling all this critical information together, insuring it is accurate, and assembling it into a claim. That’s just getting the claim filed! It still must go through the insurance payer adjudication process.
Once a claim is processed and paid, applying payments has several other challenges that are not easily automated. Billing specialists frequently must interpret payer coding error messages and correct them or submit additional documentation to get a claim successfully processed.
A Medical Billing Specialist could also be referred to as an Insurance Billing Specialist. That’s because the majority of what a billing specialist does revolves around health insurance. Health insurance can be very complex and frustrating – an it’s always changing!
In a smaller single physician office, the billing specialist may handle everything.
Medical billing and medical coding are separate but closely related. Both are critical to getting the health care providers paid.
The medical coder analyzes patient charts and assigns the appropriate alphanumeric and numeric codes. These medical codes are the standard diagnosis and treatment codes used throughout the healthcare industry.
Both coders and billers use medical records as the basis for their work. The difference is the coder used patient medical records determine the appropriate codes for the medical services. The biller uses medical records necessary for payment of these services.
In an ideal world, once the medical coder has determined and assigned the appropriate codes, it is the medical billers responsibility to use this information to prepare and submit a claim.
When the claims has been successfully paid, the medical biller posts these payments, determine what the patient is responsible for, and reconcile the accounts.
Most smaller practices cannot justify having both a coder and a biller. Since they typically they use many of the same codes over and over, it's important for the biller have some coding knowledge for the specialty. Periodically have to look up ICD and CPT codes, understand what the modifier means, and recognize when the codes are incorrect.
Situations where you have both a Medical Coder and Medical Biller is typically for larger healthcare providers - multi-physician practices, clinics, hospitals - places that see a lot of patients and have centralized coding and billing.
Oct 23, 17 09:16 PM
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Oct 23, 17 09:15 PM
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