Medical billing is an iterative process that involves the translation of a healthcare service or product in a billing claim. Ideally, the medical biller has the responsibility to make sure the healthcare institution receives sufficient reimbursement for the services provided by the medical practitioners. The responsibility of the biller may vary from one institution to the other based on size and capacity of the healthcare facility. Ultimately, the medical biller must have specialized knowledge regarding medical records and just like the medical coder; they must have strong familiarity with ICD-9-CM, CPT and HCPCS level II codes (Smiley, 2012). Most importantly, the procedures of medical billing are necessary to any given health institution because patients or insurance companies will only make payments to all procedures that deem medically correct (Lirov, 2007). For this reason, medical billers need to be specialists with the capacity to interpret medical reports into simplified and descriptive terms for purposes of billing. It is very important that medical billers interpret physician reports with accuracy to ensure that payers comprehend the claims. This essay shall discuss the role of medical billing in a medical office.
Firstly, medical billing process begins when a patient check-ins in a medical office. Ideally, when a patient books an appointment with their medical doctor, the receptionist or any other front office employee takes the responsibility of conducting pre-registration. If the patient visits the facility for the first time, their personal information is collected by the receptionist, which includes bio data of the patient (Smiley, 2012). Besides, the receptionist may also obtain insurance information of the patient. Both the bio-data of the patient and the insurance details are used to create the patient’s file, which is used as a reference during medical billing process. Creating or updating the patient’s medical records expedites the billing process and streamlines payments whenever the patient checks-in. Once the data has been entered, the patient and the insurance company can use the bill to ascertain whether the fees are charged accurate (Lirov, 2007). As such, the medical biller uses the code to confirm that indeed charges are related to the particular services offered to the patient. It is for this reason; the billers need to ensure that every billing code is billable. However, whether a code is billable or not is depended on the insurer’s policy guidelines (Schiff, 2005).
Secondly, upon conducting all medical procedures and diagnoses, all records provided to the biller are crosschecked for compliance; the medical bill is prepared and transmitted to the payer, or the insurance company. Therefore, the bill provides the payer with critical information to understand the corresponding charges to every service offered (Brown, 2013). Therefore, the medical bill acts as invoice to request for payments for services offered by the medical office from the insurance company or payer. An accurate bill ensures that the insurance company or the payer reimburses the healthcare facility accurately and at the intended time. Currently, healthcare institutions submit bills electronically, which is useful in limiting errors and reducing paper work (Fordney, 2013).
Thirdly, billing helps the health facility receive payments for services offered effectively. Ideally, when the insurance company or the payer receives a billing claim from the health institution or from a clearinghouse, the payer uses the information provided to adjudicate and determine whether the payments need to be made according to the claim. Usually, the insurance company based on the policy they have with the patient can use the billing information to ascertain whether to pay the claim in part or in entirety (Lirov, 2007). Once the claim is past the adjudication process, the payments are made to the medical office either in entirety or in part especially if the client had more than one insurance scheme. As such, the medical billing is important as a primary document for ascertaining amounts insurance pay to a claim (Lirov, 2007).
Further, a medical bill contains all the necessary information regarding the client and the services they received from the medical office. As such, the medical biller should always ensure that the patient bill has a comprehensive list of all services offered by the facility, corresponding dates and payments if any made by the insurance company. Such information is important because it ensure the health facility does not run into losses particularly because of leftover balances (Schiff, 2005). Besides, an accurate billing record shows the patient the amounts paid by the insurance company and the pending balances that must be paid by the patient. In this regard, the medical billing makes the patient understand his/her financial obligation, and remove potential sophistications in receiving reimbursements from the patient. Should the patient fail to pay the pending balance, the medical office has the responsibility to use the medical billing record to follow up for the payments either legally or otherwise (Brown, 2013).
In conclusion, medical billing is a process that begins immediately a patient enters a medical office for treatment. Patient information is collected, recorded and transmitted into a bill and further used to set up a claim. In particular, medical billing streamlines the process of payments from either the patient or the insurance company. In essence, the medical billing process ensures that fees entered for services offered are done accurately. Further, once all the diagnostic and medical services provided are entered, coded and confirmed for compliance, the medical bill is transmittable to the insurance provider or the payer as an invoice to request for payments. Ideally, the insurance provider has capacity, upon adjudicating the claim to pay entirely or in part based on their policy. Finally, should the insurance company pay in part; the health facility can use the bill to request the patient to meet his/her financial obligation by clearing the pending balances. For this reason, medical bill act as prove for pending balances and removes doubts or complexities for requesting payments from the patient.
References
Smiley, K. (2012). Medical billing & coding for dummies. Hoboken, NJ: John Wiley & Sons.
Richards, C. A. (2010). Coding basics: Medical billing and reimbursement fundamentals. Clifton, NY: Delmar, Cengage Learning.
Fordney, M. T. (2013). Insurance handbook for the medical office. Philadelphia, Pennsylvania : Saunders.
Brown, J. (2013). Medical Insurance Made Easy: Understanding the Claim Cycle. London: Elsevier Health Sciences.
Lirov, Y. (2007). Practicing profitability: Network effect for revenue cycle control in a paperless healthcare clinic. Marlboro, N.J: Affinity Billing.
Schiff, M. (2005). Medical billing handbook. Upper Saddle River, N.J: Pearson/Prentice Hall
