04/26/2024
Medical Billing 101: Everything You Need to Know.
- Basics of Medical Billing
Medical billing involves the process of submitting and following up on claims with health insurance companies to receive payment for services provided by healthcare providers.
- Key Players in Medical Billing
The key players in medical billing include healthcare providers (such as doctors, hospitals, clinics), patients, health insurance companies (payers), and medical billing professionals (coders, billers).
- Medical Coding
Medical coding involves translating healthcare services and procedures into alphanumeric codes (e.g., ICD-10, CPT codes) for billing purposes. Accurate coding is essential for proper reimbursement and compliance
Claim Submission
After services are provided, medical billers submit claims to insurance companies electronically or via paper forms, including patient information, diagnosis codes, and procedure codes.
- Claim Adjudication
Insurance companies review claims for accuracy, completeness, and compliance with policy guidelines. They may approve, deny, or partially pay claims based on the information provided.
- Payment Posting
Once claims are approved, payments are received from insurance companies and posted to the patient's account. Any remaining balance not covered by insurance becomes the patient's responsibility.
- Denials and Appeals
Claim denials may occur due to coding errors, incomplete documentation, or insurance coverage issues. Medical billers handle denials by identifying the reasons, correcting errors, and submitting appeals if necessary.
