What is Medical Billing?

Medical Billing Form

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice.

Is Medical Coding the Same as Medical Billing?

No. The main responsibility of a medical coder is to review clinical statements and assign standard codes using CPT®, ICD-10-CM, and HCPCS Level II classification systems. Medical billers, on the other hand, process and follow up on claims sent to health insurance companies for reimbursement of services rendered by a healthcare provider. The medical coder and medical biller may be the same person or may work with each other to ensure invoices are paid properly. To better understand what a coding transaction looks like, read the article "What Does a Medical Coder Do?"

What Do Medical Billers and Coders Do?

Medical billing and coding specialists are largely responsible for making sure medical office revenue cycles run smoothly. When a service is performed, a medical coder assigns codes to the services rendered. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician's notes, laboratory and radiologic results, etc.

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 healthcare professionals to clarify diagnoses or to obtain additional information. 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-10-CM codes.

How Much Do Medical Billers Earn?

Medical Billers Earn

A medical biller’s earning potential varies depending on where they live, work, how much they work, education, certifications, and their experience. AAPC conducts an annual salary survey where you can learn more about medical coding salary trends. The average AAPC medical biller earns over $61,000 annually.

What is the Occupational Outlook for Medical Billers?

The 2012-2013 edition of the Occupational Outlook Handbook, published by the U.S. Department of Labor, estimated industry employment is projected to grow by 21% by 2020. In addition, they project high demand for coding services as the healthcare industry continues to grow and the country's population ages in addition to the increasing number of tests, treatments, and procedures.

How Do I Become a Medical Biller?

AAPC, the largest medical coding and billing training and certification association in the world provides the flexible training options to become a medical biller. The training provides the most up-to-date information relating to the health insurance industry and different reimbursement methodologies for correct claim submission. Successful completion of AAPC training prepares you to sit for the certified professional biller (CPB) exam and work in a medical billing department at a physician's office, clinic, facility, other healthcare entity, or as a claims examiner for insurance carriers. Prepare for your certification and career in medical billing today!

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Why Get Trained with AAPC?

AAPC provides industry leading training and certification and is recognized as the largest association representing medical coders, billers, auditors, compliance, and practice managers. AAPC certification is considered to be the gold standard in the industry. AAPC provides the largest peer-network for medical coding and billing with over 155,000 members worldwide.

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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 healthcare offices to have highly skilled 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 and maximize 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
  • Implement best practices for insurance and patient collections while maintaining excellent public relations
  • Reduce risk 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

Questions? Contact an AAPC Career Counselor for a free consultation to learn more about medical billing and coding. Contact us online, via email, or by calling 800.626.2633.

Which certification is right for you?

Call 877-290-0440 or have a career counselor call you.

Questions about what books to order?

Call 877-524-5027 to speak with a specialist.