Medical Billing is the process of submitting claims to insurance companies to receive payment by a doctor or health care provider for the services rendered by him to a patient.

When the patient comes to the health care provider, he first examines the condition of his patient and then makes a medical record depending on the examination. The medical report will contain a summary of treatment given to the patient and demographic information related to him.

The Process:

Medical Billing will take place after an interaction between the heath care provider and the insurance company. To determine the procedure code the treatment given, the diagnosis and the duration of the treatment will be combined and then used to bill the insurance company. The provider can do this with the help of a billing specialist or a medical coder after which a billing record will be generated. This claim is then passed either directly to the insurance company or to a clearing house which plays the role of an intermediary.

After this the procedure for medical billing will begin with the insurance company first checking if the claim is valid or not. They do this by checking the patient eligibility for payment, credentials of the health care provider and medical necessity. Once this test is passed the provider will get his claim but if the claim fails the test the claim gets rejected. The provider will be notified immediately.

The good thing about medical billing is that even after getting rejected, the provider can resubmit the claim by reconciling with the original claim and making necessary corrections. Until the provider gets his claim this exchange of claims and messages may repeat multiple times. It has been recorded that the frequency of rejection is almost 50%. Before all medical billing used to take place on paper but thanks to computers now this can be managed efficiently no matter how large the amounts of claims are. Even medical billing softwares are available in the market.

The Amount Paid:

The insurance never pays the full amount claimed by the provider. Depending on the amount negotiated by the company and the provider, the original claim gets reduced. This gets further reduced if the patient has a deductible, copay or a coinsurance. A coinsurance means the patient has to pay certain percentage of the amount. If a patient has copay then the doctor will be paid the negotiated amount minus the copay amount. If the patient has a deductible say $200 then he would have to pay this amount in installments until the deductible is met at which point the insurance would begin to cover a portion of the charge.

When choosing a billing center first find out about their reputation. Past experience always counts. It is not necessary that it should be a big billing company even small companies can offer the best service that you want. You just have to look for them and moreover they can offer your practice a more personalized service!