What is Medical Billing? Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider.
For many years, medical billing was done entirely on paper. However, with the advent of technology it has become possible to efficiently manage large amounts of claims through medical practice management software. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of medical billing and medical office management have created the necessity for specialized training.
What do medical billers do?
The billing process often begins as soon as the patient makes an appointment with the medical office, as codes may be entered and submitted to an insurer for pre-approval. After the coding is completed, medical billing specialists generate invoices and send the claims to patients’ insurance providers (or other payers). A medical biller needs to understand the industry codes even if someone else does the coding, since the billing specialist has to review the reasons behind any denied insurance claims and may be responsible for updating the codes before resubmitting the claims. They will also verify the codes are entered correctly before submitting the initial claim.
The day-to-day work of a medical billing specialist includes:
- Reviewing properly coding services, procedures, diagnoses, and treatments
- Preparing and sending invoices or claims for payment
- Correcting rejected claims
- Tracking payments
- Following up with patients and insurance companies about outstanding bills