Medical Billing Companies: How They Work

Perhaps you have heard a lot about medical billing and coding professions and have always wondered what these companies actually do. This article would take a closer look at the medical billing profession and how it functions.

The medical billing companies essentially make sure that the doctor or any other health care provider gets paid for the services rendered to the patient. In America there are thousands of doctors, many of whom have no clue how to get paid for what they do. Of course all payments come from insurance. But how are insurance claims made and who makes those claims? This is where the role of the medical billing professional comes in.

It is the medical billing companies who make those claims to the insurance companies to receive payment which is due to the healthcare provider for treating patients. The process involved is essentially same both for privately owned or government-owned insurance companies.

The whole process of course starts as soon a patient visits the medical center. The doctor examines the patient and then diagnoses his ailment. He then chooses the most appropriate treatment for the patient. Depending on what transpired between the doctor and the patient, the doctor updates the patients' medical records. Each of these patients' records contain summary of the treatment provided and all the demographic details about the concerned patient.

From this point onwards, the medical billing professional takes over, analyzing the data and matching them with the enormous database of numerical codes which the insurance companies use.

Information gathered include treatment, diagnosis and tenure of service rendered which form the procedure code which is used in the billing of insurance. Of course the doctor could handle the claims processing him self but the process is long and tiring and the doctor would rather prefer to spend time with his patients. This is the reason why he opts for medical billing companies to do the processing for him.

The billing record is formulated by the medical billing companies based o the information provided to them by the doctor. This type of record is usually generated either manually or through a software program. This form would include the various diagnoses as identified by numbers from the current ICD-9 manual.

This billing record is submitted to the clearing house, who acts as an intermediary, by the medical billing companies. Usually when billing records are generated electronically, they are sent to the clearing house.

Of course sometimes the billing records are directly sent to the insurance companies. This ensures that all the records have been processed with optimum efficiency. Though this is an extremely simplified version of how medical billing companies function, the actual insurance reimbursement and medical coding processes are extremely complicated. This is the reason, why it needs the expertise of a professional who has a sharp eye for details, is familiar with medical terms and can operate the relevant software. He also has to be knowledgeable about the enormous numerical medical coding system which is currently in use in this country.

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