Medical billing is a routine payment procedure within the US health sector. The procedure involves a health care provider submitting, upon receipt of claim, documentation outlining treatments rendered for a particular patient; including tests, procedures, and treatments; and diagnostic tests. The billing and coding practitioner obtains information from a patient's insurance company and other sources to assign a bill for services rendered, including the costs associated with the treatment. The bill is then paid by the patient to the designated payer.
Medical billing and coding specialists are employed by healthcare providers, including hospitals, primary care providers, outpatient clinics and other such facilities. They are required to have a thorough knowledge of healthcare services, specific medical codes assigned to each category of services, and the physiology and anatomy of human beings. These professionals also need to understand the clinical documentation needed for reimbursement and billing purposes. Medical billing and coding technicians therefore, need to be proficient in various concepts, including administrative, information systems, math, statistics, technology, writing, auditing, decision analysis, accounting, human anatomy, physiology, medical law, business law, insurance claims processing, billing, and coding.
Medical billing and coding require knowledge of medical record management software. This software helps billing and coding practitioners to properly organize and classify data used in the billing and coding process. Such software makes it easier to access patient information to ensure accurate reimbursement and timely billing. It allows for efficient billing, less fraud and clerical error, simplified billing procedures, improved coding practices, reduction in duplicate billing and fewer medical claims filed for unneeded or unnecessary healthcare services.
Efficient billing and coding facilities are needed to maximize revenues. Medical billing and coding staff should be able to efficiently process hospital and healthcare claims. The process needs to be fast, accurate, and efficient. Billing firms must be able to meet the demands of hospitals, doctors, clinics, and private patients. Hospitals, clinics, and other such facilities want their bills to be paid quickly. And private patients want their healthcare providers to meet their requirements promptly and professionally.
Medical billing and coding are an excellent way to improve the quality of care provided by health care facilities. In the past, medical billers and coders were not very knowledgeable about health information technology. As a result, the accuracy of their coding and billing was often questionable. As more healthcare facilities, doctors, clinics, and other institutions started using electronic medical records, the quality of their coding and billing has dramatically improved.
An accredited medical coder and billing specialist should be well trained in the use of digital patient records (DPR) and electronic medical billing and coding software. They should be familiar with basic anatomy and physiology, medical terminology, diagnostic, medical code sets, insurance jargon, health plan terminology, diagnostic imaging terminology, diagnostic drug name (IDN), preferred provider organizations (PPOs), preferred drug list (PDL), and pharmacy refill terminology. They should have a thorough knowledge of how health information technology (HIT) works and should be familiar with the latest editions of electronic patient records (EPRS) and health care delivery software. Medical billers and coders must also have good English communication skills and are aware of healthcare policy, ethics, and legal requirements for billing clients and facilitating documentation of diagnoses and procedures. Medical billing and coding specialists are an integral part of the medical office management team.