The Medical Billing Process of Filing Insurance Claims

The health care revenue cycle is managed by medical billers and coders. The process is very important in the administrative side of health care because this process enables physicians to get paid for all the life saving services they rendered to patients who opt to pay for medical services using their medical insurance coverage.

Without the medical billing process or the professionals doing this work, the entire health care system which is recently very dependent on health care insurance, will collapse.

For those who are thinking of starting a career in the medical billing and coding field, here’s a guide on the medical billing process, particularly on filing insurance claims.

The medical billing process is triggered or starts upon the first time a patient makes a visit to a physician or any health care service provider. A medical record will be prepared for the patient. It will contain initially the patient’s personal information as well as insurance information which will later on be verified.

On the first visit, the physician will give the patient one or more diagnoses; this is done to streamline the healthcare that will be provided. Later on, the diagnosis will be used as claims basis. If there’s no definite diagnosis, the reason for the patient’s visit will be used in the claim.

The information on the medical record later on will be used to fill-up a health insurance claim form. The services will still be indicated in the insurance claim however it will be coded using CPT and ICM-9, these are generally accepted medical codes describing medical services rendered. These codes are standard across the entire health care industry, making it easy to understand the medical procedures and treatment rendered.

The claim form will either be sent electronically to the health insurance company or sent through conventional methods like mail or fax. After the claim is filed, it is then the duty of the medical biller and coder to monitor the status of the claim, whether it will be settled, denied or rejected.