Medical billing is an invoice payment process within the United States healthcare system. The process usually involves a health care provider submitting claims for payment of medical services rendered; including tests, treatments, and diagnostic procedures. When a provider submits the appropriate claims to the applicable payer, the payer takes possession of the items or documents related to the services rendered and passes the applicable bills on to the appropriate party. The types of billers are usually medical billers, pharmacy bills, and office service billers.
The main goal of medical billing and coding is to provide a seamless revenue cycle for payers, insurance carriers, and providers. Medical billers are responsible for collecting payments from payers for treatments rendered by providers, while providing the necessary reports to the relevant payers and related authorities. It is also the responsibility of these billers to maintain accurate accounting systems and data. The data is used to maximize collections, claims processing, and claims reimbursement.
The primary function of medical billing and coding is to convert health information and tests/imens to a universal CPT code. This code is used universally to represent the patient visit, diagnosis, treatment, outcome, and procedural details during the procedure. Each CPT code has multiple parts and different numbers of code values, which are required to be submitted with claim forms. Billing and coding specialists also ensure that all patient visit information is correctly recorded, while maintaining the accuracy of coding and payment information.
Medical billing and coding require knowledge of healthcare policies, practices, regulations, payment procedures, billing procedures, patient claims, health information technology, patient education, reimbursement processing, fraud prevention, patient safety, electronic health record systems, electronic medical records (EMR) and healthcare economics. These are just some of the subjects that medical billers and coders must be familiar with, in order to become professionals in their field. There is always room for professional development for medical billers and coders.
Becoming a medical biller or coder is not as easy as it seems. A certification program or an associate degree is usually a minimum requirement for getting a job in this industry. There are also several other things that medical billers and coders have to do in order to provide quality services to their clients. Graduates of training programs may need to pass state examinations in order to ensure that they are properly trained.
Medical billing and coding do not require any specific academic preparation. Both students who have finished high school and those who have studied in universities can participate in training programs. Online learning is another option for students who cannot attend regular classes. However, in addition to learning medical billing and coding information, they must complete assignments on the particular topic, under the supervision of an experienced instructor. These assignments cover everything from the history of the disease or injury, to the claims procedure and reimbursement rates.