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What is Medical Billing?

 

Medical Billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government-owned.

In brief, when a physician or any licensed healthcare provider sees and offers some sort of treatment to a patient, the healthcare provider wishes to be paid for the services rendered. If the patient directly pays to the treating physician, the process is over there itself but when the patient has a medical health insurance, the physician has to submit a claim on the patient's behalf to the corresponding insurance provider for approval of the payment for services provided.

Usually, an HCFA (a standardized format) for billing record either in paper or electronic media is used which is an authorization directing the insurer to make payment directly to the health care provider rather than to the insured. The insurance provider after receiving the claim then determines if benefits are to be payable and how much of the total amount filed.

The generation of this electronic record or on paper is the work of the medical biller. The medical biller is responsible to translate medical terminology, diseases, diagnoses and procedures into coded billing statements (ICD-9 and ICD-10 codes), enter patient information into databases, mailing patients’ billing statements to the insurance providers, checking for payments received, and following on for unpaid insurance claims. Hence, an efficient, educated and well informed medical biller is required to file claims properly so that they are not rejected or disapproved.


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