Medical billing and its sibling, medical coding, are liable for translating medical intervention into financial information. However, while coding occurs mainly in the background to quantify the reimbursement due for services rendered, billing is essential to the revenue cycle of medical systems by overseeing payment processes.

The role of medical billing is critical as it entails verifying the insurance coverage of patients, collecting copays, securing the authorization, and transmitting the assigned codes meant for insurance claims. 

Let’s take a deeper look into medical billing.

Components of Medical Billing

Medical billing can seem like a complex process, but the great thing is, it’s easy to demystify. Here’s a quick look at two components necessary for billing.

Front-End Billing

A medical biller collects information from the moment a patient walks in to register and schedule an appointment. The procedure consists of getting patients to fill in forms that confirm their home address and insurance coverage. Also, when the patient is checking out, billers will collect the co-payments.

A function of front-end billing is for the biller to confirm the patient’s financial responsibility. This means verifying whether the services the patient needs are covered by the insurance and submitting prior authorization where necessary. 

Back-End Billing

Once a patient checks out, coders will use their medical records to generate billable codes. This process is known as creating a superbill. Back-end billers will use the information from these superbills to transmit claims to insurance providers and other payers. 

The Medical Billing Process

The billing process can be broken down into eight steps. These are

• Registering Patients: Take details of new patients, including personal and insurance information.

• Confirming Financial Responsibility: Verifying whether the patient’s insurance coverage is sufficient for the services they require.

• Checking Patients In and Out: Asking patients to provide details when checking in and collecting co-payments before leaving the medical center. 

• Preparation of Claims and Checking Compliance: Receiving the superbill from the coder and preparing a claim form to submit to the billing software.

• Transmitting Claims: As per HIPAA Act 1996, medical providers must submit their claims. 

• Monitoring Adjudication: Once the payer receives a claim, they’ll put it through a process known as adjudication. The claim may be accepted, rejected, or denied. Rejected claims can be resubmitted with corrections. Denied claims are primarily due to procedures that payers do not cover. 

• Generating Patient Statements: The biller receives reports from the payer detailing what they are covering. If only a portion of the claim is paid by insurance, the balance is passed on to the patient. 

• Following Up on Patient Payments and Handling Collections: The biller is responsible for sending statements to patients and paying the bills. Once paid, the file is closed. In case of delinquency, several options are available to the biller to recover the amount owed to the medical providers. 

 Need Help with Medical Billing?

As you can see, medical billing is an involving process. You need the right people to get you started on the right path. They should have the appropriate mix of experience, knowledge, and innovativeness to help you jumpstart your career. That’s us. If you’d like to know more about how you can conquer this field, fill out the form below to contact our team.