What is Medical Billing?

Medical Billing Form

Medical billing translates a health care service into a billing claim. The responsibility of the medical biller in a health care facility is to follow that claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.

Although a medical biller’s duties vary with the size of the work facility, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up and patient follow-up. Medical billers regularly communicate with physicians and other health care professionals to clarify diagnoses or to obtain additional information. Therefore, the medical biller must understand how to read the medical record and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.

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Why is Medical Billing Training and Certification Important?

The financial health of a practice largely depends on the performance of the billing office. Increasing demands on providers with decreasing reimbursement requires health care offices to have highly skilled individuals for medical billers. Understanding of medical insurance, the claims process, the appeals process, and the impact on the practice’s revenue gives the medical biller the tools to successfully optimize a practice’s revenue performance.

Skills of a Medical Biller

  • Navigate through various insurance rules and regulations to reduce A/R days.
  • Understand the nuances of various types of insurance carriers along with their claim requirements.
  • Provide successful follow-up efforts for A/R including the appeals process for denied claims.
  • Practice best practices for insurance and patient collections while maintaining excellent public relations.
  • Reduce risks by understanding Fair Debt collection practices, professional courtesy regulations, clean claims and timely filing guidelines, Refund requirements, and other regulations.
  • Use data and reports as indicators for potential improvement areas.