FUNDAMENTALS OF MEDICAL BILLING

 

SUMMARY: Medical Billing and Coding are the backbone of the healthcare revenue cycle, ensuring payers and patients reimburse providers for services delivered. Billing and coding are separate processes, but both are crucial to receiving payment for healthcare services. Medical billing uses those codes to create insurance claims and bills for patients. Medical billers take the codes prepared by the medical coder and submit claims to the insurance company. They then follow up with both the insurance company and the patients to make sure the medical office is compensated properly, the patient is billed correctly, and timely payments are made.

In the following article, we shall be getting an idea of the basics and fundamentals of medical billing.

A vital process in the perpetual functioning of any hospital or medical office or clinical research courses is medical billing. Medical billing involves preparing billing claims and submitting them to insurance providers. This ensures that the hospital or medical office is reimbursed the correct amount for the services that they provide patients.

Medical offices receive money from private insurances providers and various healthcare programs, such as Medicare and Medicaid, which are provided by the government. Receiving proper funds allows the medical office to stay open. With suboptimal reimbursement, it is difficult for them to provide stellar healthcare to patients.

MEDICAL BILLING WORKFLOW:

Fundamentals of Medical Billing are basically how it works out or goes about. There may be a slight difference between workflow of different medical offices, but they still revolve around the basic fundamentals.

·        Patient Registration: Patient registration is the first step on any medical billing flow chart. This is the collection of basic demographic information on a patient, including name, birth date, and the reason for a visit. Insurance information is collected, including the name of the insurance provider and the patient's policy number, and verified by medical billers. This information is used to set up a patient file that will be referred to during the medical billing process.

·        Financial Responsibility: This means looking over the patient's insurance details to find out which procedures and services to be rendered during the visit are covered. If there are procedures or services that will not be covered, the patient is made aware that they will be financially responsible for those costs.

·        Creation of Superbill: Once the patient checks out, medical reports from the visit are translated into diagnosis and procedure codes by a medical coder. Then, a report called a “superbill” may be compiled from all the information gathered thus far. It will include provider and clinician information, the patient's demographic information and medical history, information on the procedures and services performed, and the applicable diagnosis and procedure codes.

·        Claims Generation: The medical biller will then use the superbill to prepare a medical claim to be submitted to the patient's insurance company. Once the claim is created, the biller must go over it carefully to confirm that it meets payer and HIPPA compliance standards, including standards for medical coding and format.

·        Monitor Claim Adjudication: Adjudication is the process by which payers evaluate medical claims and determine whether they are valid and compliant, and if so, the amount of reimbursement the provider will receive. During this process, the claim may be accepted, rejected or denied.

·        Patient Statement Preparation: Once the claim has been processed, the patient is billed for any outstanding charges. The statement generally includes a detailed list of the procedures and services provided, their costs, the amount paid by insurance and the amount due from the patient.

·        Statement Follow-Up: The last step in the medical billing process is to make sure bills are paid. Medical billers must follow up with patients whose bills are delinquent, and, when necessary, send accounts to collection agencies.

Medical billing and coding specialists and clinical research training and specialists can work essentially anywhere they wish due to the robust demand for workers in the healthcare field.