Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for healthcare services provided to patients. It involves translating medical procedures, diagnoses, and treatments into universally recognized codes.
Here are some key points about medical billing:
Insurance Verification
Before providing healthcare services, medical billers often verify the patient's insurance coverage and eligibility. This step ensures that the services will be covered, reducing the chances of claim denials or payment rejections.
Claim Submission
Once the coding is completed, medical billers compile the necessary information, including patient demographics, insurance details, and the coded services, to create claims. These claims are then submitted to the appropriate health insurance companies for payment processing.
Claim Adjudication
After submitting the claims, health insurance companies review them to determine the covered services and reimbursement amounts based on the policy terms. This process is known as claim adjudication.
Denials and Appeals
In some cases, claims may be denied or only partially reimbursed. Medical billers appeal these denials by providing additional documentation or clarifying the information to ensure proper reimbursement.
Payment Posting
When claims are approved, the insurance companies send payments directly to the healthcare providers. Medical billers post these payments to patient accounts, adjusting for any co-pays, deductibles, or contractual agreements.
Patient Billing
Medical billers also generate invoices for patients, detailing the services provided and the remaining balance after insurance payments. They manage patient inquiries, set up payment plans, and assist with financial arrangements.