The medical billing and coding process is the part of the health care system that manages the health care revenue cycle and is focused on health insurance claims submission and monitoring. The professionals in this field coordinate with representatives of the health insurance companies to file reimbursements for services rendered to insurance policy holders who availed of medical services but opt to settle using their health insurance coverage.
The medical billing process is mostly about the coordination between health care service providers and health insurance companies. The whole of this interaction is termed the medical billing cycle. The interaction between health care service providers and the insurance company may take anywhere from a day to several weeks depending on the health care rendered, complexity of the claim and the accuracy of submitted information.
The medical billing process is triggered the first time an insured patient visits a health care provider. The physician or their assistants must prepare a medical record for the patient if there’s no record on file yet or update their record if they are a regular patient of the health care service provider.
The medical record of the patient must contain the summary of treatments performed or the diagnosis made for the patient. This information will be used in the health insurance claim as basis for services. The medical biller will keep track of the medical record and then properly convert the information in the medical record into its equivalent generally accepted standard medical code. These codes will be used in the insurance claims form representing services rendered.
After a claim is submitted, the counterpart of the medical billers on the side of the health insurance companies will check the accuracy of the claim and will either approve the claim for settlement or reject the claim. Once rejected or approved, the medical biller will inform the health care service provider about the status of the claim and in the case of rejection, will make corrections on the rejected claim and resubmit it.
That’s the general overview of the medical billing process.