The Medical billing process is a payment practice between patients, insurance, and providers (Doctors) in the United States health care sector. Medical billing is also known as managed care practice in the United States of America’s health system which is involved with lots of Health Care activities in it. Some of such activities include submission of forms, following them, getting associated with healthcare insurance companies in order to get payment for treatments or any procedures.
This is perhaps the basic procedure used given by the health insurance companies irrespective of whether they are private or government companies. However, the medical coding reports will help in analyzing the diagnosis and treatment that includes price listing. It is too good to be true that medical bills are essential but are not required by any sort of law in order to get certified in various examinations CPB Exam, CMRS Exam, CPC and so on.
There are some certification schools that are integrated in order to help you provided me theoretical guidance for students who would like to take medical billing as the field. So here you are going to explore a lot related to medical billing and things related to it.
Type of Medical Billing
In the medical billing process, there some segments or types of work divided by their nature of work and specialization. List is as below
- Professional Billing:
This is a type of billing that involves claims which are generated especially for work performed by physician or any other non institutional provider for both inpatient as well as outpatient services. CMS-1500 form is where the professional charges are billed. This CMS-1500 is a white color paper with red ink that is used by the physician sand suppliers that will help in claiming the bill.
- Institutional Billing:
Institutional bill is another type of bill which is mainly responsible for bills that are claimed for work that is performed by skilled nursing facilities, hospitals or any other institutes which includes both inpatient and outpatient services along with equipment, radiology services, other essentials. Here UB-04 is where the bills are charged which is a white color paper with red ink that is used by all the institutional providers for claiming the bill.
- Adjudication
Adjudication is also part of medical billing but in this type of work, we normally work from the insurance side. Above mentioned profiles, we have to work for providers or hospitals but in adjudication, we have to work from the insurance side to process the claim for correct payment and denials. In this type of profile, knowledge of basic medical billing is required to understand the claim process.
10 steps in the medical billing process
This question always ask in interviews in medical billing and coding jobs that “what are the 10 steps in the medical billing revenue cycle?” For step by step knowledge of the medical billing process please refer below-given points and details.
- Patient Registration
- Insurance Eligibility and Verification
- Encounter
- Medical Transcription
- Coding of procedures and diagnosis
- Charge Entry
- Claim Submission
- Payment Posting
- Denial Management
- AR Follow-up
1- Patient Registration:
When a patient comes to the provider’s office or hospital during this stage the patient’s demographic information is taken and is saved. The demographic information includes policy number, information related to the insurance pair, and other essential information required cleaning claims. This is the first step called patient registration.
2- Insurance eligibility and verification:
It is too good to be true that the insurance information may be changed from time to time therefore it is essential to provide individuals eligibility each time you make use of a service. This information is also essential to get benefited and get claim approval swiftly.
3- Encounter
The patient healthcare condition is recorded by audio or video. In this step patient’s condition, and medication along with provider’s prescription recorded for further processing.
4- Medical Transcription
Medical transcription is also part of medical billing and in this step recorded audio is listened by medical transcriptionist and converted into medical script.
5- Coding of diagnosis, procedures, and modifiers
This is one of the essential steps of medical billing process, it will help in fixing the procedure as well as the diagnosis code for patients based on the Standard such as CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases).
6- Charge Entry:
This is nothing but entering of charges especially for the services that you receive includes appropriate linking of medical codes the services and procedures that are executed especially when the patient takes the visit.
7- Claims submission:
In this part of the process once the claim has been completed then and the external party is submitted for payment to the insurance payer. Before claiming it is essential that the below should have information related to the insurance company.
8- Payment posting:
The final step is the Payment posting which involves both the posting and the deposit functions along with the reconciliation of posting activities with deposits.
9- Denial Management
When any claim processed from insurance company there is 3 type of status either claim will be paid, or pending or received a denial due to any reason. The medical billing executive handles the denial and take action to solve the claim and send for reprocessing. This is called denial management.
10- AR Follow Up
This is the final stage of the medical billing process where the teams go ahead with the insurances along with payment agencies making sure that they reach the last stage of it.
In AR-follow up, the medical billing executive usually calls to the insurance company and take followup for the denial reason. If there is some information required which is already available in the patient account, provided by the executive and request for reprocessing the claim. In some cases, extra medical documents of the patient required so take the correct fax number or mailing address and sent the documents to the insurance company. We can understand the medical billing process by the flow chart given below
Medical Billing Process Flow Chart
Medical billing process flow chart is a step by step process description which we follow in complete process of claim. This flow chart explains each and every step from patient registration to claim denial handling.
What do a medical biller and coder do?
Both the medical biller as well as the Coder has same type of work irrespective of any type of facilities they are employed in. Right from the clinics to hospitals to physicians’ offices they make use of medical codes as well as information related to the patients. In addition to that, the medical biller duty includes,
- Making use of codes in order to build the insurance provider.
- Understanding the code characters for patient records.
- Maintaining records of the patients analyzing and reading them.
- Getting interacted with the positions and assistance to maintaining accuracy.
- Taking care of all the essential information especially the code details.
- Keeping an eye on the patient’s information and number of visits.
- Checking the patient’s confidential and maintaining information security.
Basic tips
Here are some medical billing tips for people who use software that will help in boosting the revenue and efficiency.
- Go through the terms of medical billing especially on the note provided in the receipt.
- It is essential to update the billing information in your system so that it will be easily depicted on your website.
- Get clear information regarding the methods of payments that are currently accepted.
- Cross check the details such as patients to avoid building delay that may cause any sort of topographical errors.
- Go through the latest version of the revenue cycle management software that will keep you updated so that you can minimize errors.
What are the medical billing codes?
- ICD:
ICD stands for International Classification of Diseases, or ICD codes. These are Diagnostic codes that are designed with an even vocabulary for describing the cause of any e health related issue.
- CPT:
Abbreviated as Current Procedure Terminology, or CPT, codes, that are used in order to document majority of medical procedures that are take place in any of the physician’s office. This is further divided into 5 digital codes which are even divided into three different categories. Here’s a quick look at the sections of Category I CPT codes, as arranged by their numerical range.
- Evaluation and Management: 99201 – 99499
- Anesthesia: 00100 – 01999; 99100 – 99140
- Surgery: 10021 – 69990
- Radiology: 70010 – 79999
- Pathology and Laboratory: 80047 – 89398
- Medicine: 90281 – 99199; 99500 – 99607
- HCPCS Codes
Healthcare Common Procedure Coding System (HCPCS), which is also known as “hick picks,” which is a set of some basic codes. Has been developed by CMS and it is under the maintenance of AMA.
Who is the billing provider in healthcare?
A medical billing provider is a person who orders or even refers an item or a service referring to the medical beneficiary such as the tests, diagnosis, services and medical equipments which can be furnished and billed by another provider or even a laboratory.
Therefore the provider will consider the medical billing as a process of either submitting or following up on claims established with the health insurance companies that would be receiving payments for various services that are rendered by the health care provider.
What does a medical coder do?
Medical code in health care basically collects information regarding the treatment, diagnosis, medication, procedure, and even the equipment and then converts them into Alpha numerical codes. This medical code is collected from various sources like medical notes, transcriptions, lab reports, blood work, urinalysis and pathology and radiologic assessments. However the medical coding professor will take the responsibility of transferring these codes directly into the codes from the source in order to translate them into the medical billing system along with records of the individual patients.
Coding is essential in order to go ahead with medical claims along with insurance and bills for both the insurance as well as the patient. However the medical coding is one of the essential aspects in moving the democratic assets along with the study of the disease, treatment involved and accountability-based reimbursement systems.
What is RCM (Revenue cycle management) in medical billing?
Revenue cycle management (RCM) is considered as the financial process that is analyzed with the help of medical Billing software which is used by the Healthcare facilitators that will help them to track the information related to the patient. Right from the registration to the appointment schedule to the final payment procedures the Revenue cycle management places a very important role. RCM unifies both business and clinical side of the Healthcare there by combining data such as information of the patient like name, insurance provider details and other personal information along with the treatment of patient receives and their Healthcare information.
RCM main asset is the way in which they communicate with the Healthcare insurance companies. The information that they collect especially when an individual takes an appointment to meet a physician then the hospital staff will go through the patient’s record and know about their health information before they could actually visit the hospital. As soon as the insurance patient gets the treatment for a given condition and then supplies and applicable payment where the health care provider categorizes the nature of the treatment as per the ICD-10 codes and will inform the same to the insurance company.
What Is Medical Billing Software?
Medical building will act as a Gateway between the Healthcare provider as well as the patient’s medical insurance company. The software has been enhanced in such a way so as to provide a better way to get access to various documents rather than keeping them in a file or a folder.
One of the essential features you have to determine in the medical billing software is that it is involved with claiming procedures where the system validates each claim and then the code is used before they are sent out for any corrections such as code errors.
In addition to that, the software is also included with the possibility to verify the patient’s eligibility as well as to know the insurance status. It is essential to know the information because this will help in the proper maintenance of all the issues related to health.
What is medical billing jobs?
if you looking for a new career in healthcare you should consider medical billing and coding jobs, this career offers average starting salaries of about $40,000 a year and the US Department of Labor and AAPC(American Academy Of Professional Coders) expects it to add over 50,000 new jobs in the next few years which is the growth of 20% in medical billing and coding profile is also a great choice because you can gain all of the skills you’ll need through an online certificate course. You also have the opportunity to get a remote medical billing job or medical billing jobs from home also.
Working Profile:
Now let’s talk about what is the working profile in this type of job. You will do as a coder or a medical biller. As your primary job will be assigning standardized codes to all tests, treatment procedures as per the medical records of the patient. As a medical biller, you have other segments of work like payment posting, charge posting, handling denials, and rejection of claims. In a patient’s record medical billers then use the coded reports to collect payment from insurance providers and patients because you’re working more behind-the-scenes medical billing and coding is a great career choice if you want to work in healthcare.
Billing and coding are vital to the healthcare industry because if records are coded then doctors clinics and hospitals won’t get paid these physicians are incredibly important but unfortunately for employers and fortunately for you there is currently a nationwide shortage of medical coders and over 50% of employers report having open coding physicians this means there are lots of jobs out there. Due to COVID-19 a huge opportunity for medical billing and coding jobs from home also generated every month.
just waiting to be filled with certified professionals and medical coding and billing don’t have to be just a job to tide you over it is a real career once you have the education you need to get started you can progress to inpatient coding or speciality coding or even management positions with a little additional experience or education taking a certificate program in medical coding and billing.
Medical billing and coding are excellent starting places for a rewarding lifelong career.
Basic Knowledge Required
you will need to understand things like medical terminology anatomy and physiology and even pharmacology
you will use and help you gain hands-on experience with real medical records and reports all of varying levels of difficulty these reports have been provided standard and billing and coding software and you will even practice coding emergency room reports lab reports physical therapy orders and more while you are gaining this experience you will see the importance of having depth knowledge of Human Anatomy, medical billing abbreviations and definitions, human body terminology and concepts so you can correctly assign codes because remember if the codes are not correct people don’t get paid to work with hundreds of real medical records helps your learning experience match as closely as possible the experience you will have on the job that way you’re ready to earn your industry credential and start working as soon as you finish training.
certified professional coder or CPC exam offered by AAPC employers generally only look for one of these credentials when they’re screening applicants so by being prepared to learn both you’ll have more flexibility in your job search the career step program is specifically designed to let you study at your own pace on a schedule that fits your busy life while preparing you to get the job you’ve always wanted it’s easy to get started.
For starting a job in medical billing and coding, the minimum requirement is graduation and knowledge of computers, if you are graduate in the science stream or life science it will be beneficial for you
- E-clinical works
- United Health Group(UHG)/ Optom Health
- Gebbs healthcare
- Nthrive Global
- Pacific BPO
- R Systems
- EMD
- Accenture
- Access Healthcare
- Hinduja Healthcare
- R1 RCM
Best Medical Billing and Coding Job Search Portals:
S.N. | Job Search Website | Job Website Link |
1 | Appjobs | |
2 | Crowdspring | |
3 | Uxjobsboard | |
4 | Resume Robin | |
5 | Jobsoid | |
6 | Fiverr |
There are a lot of companies in India that run the medical billing process with opportunities in medical billing and coding jobs profile above listed, some known companies working in this field from a long time, and also providing medical billing jobs from home also. Most of the time companies which hire you as a fresher provide the basic knowledge and training before starting the work.
Free Medical Billing & Coding Course
Useful Links
1- The Basics Of Medical Billing
2- CPC Exam Study Guide – 2020 Edition
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