Medical billing professionals are a vital piece of the puzzle in the medical industry, facilitating the exchange of money between patient, doctor and insurance company. Medical billers usually work in a clinical setting, although an increasing number work independently from home. Billing professionals have little to no contact with patients, making their job more predictable and relaxing than most medical professionals.
Medical billing is a complex process that requires a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations and medical codes.
When a patient visits a doctor, the physician updates the patient’s medical record with a diagnosis and a summary of procedures and services provided. Based on this information, the medical biller submits the claim to the patient’s insurance company — often from home — for an appropriate amount of money to cover the services. The insurance company either approves the claim for a percentage of the amount billed or rejects the claim altogether.
If the latter occurs, the biller makes adjustments based on the insurance company’s input. Because of the complexity of claims and the high probability of data entry errors, rejection is common. Claims are often sent back and forth several times between medical billers and insurance agencies.
Medical billers not only submit claims and track payments, but they also analyze records to produce profitability reports, advise doctors of new fees and practices, work on clarifying Medicare claims (as mandated by government regulations) and often even handle medical transcription duties.
Medical billing works closely with the process of medical coding, or translating medical diagnoses and procedures into code numbers that can be understood universally. There are codes that are used for billing, and others that are used for purposes like ambulatory settings, physicians’ offices and long-term care.