Medical Billing: How Is It Done?

When a person has a health insurance from a certain company, he/she is probably familiar with the process called medical billing. It is actually the process in which a medical billing specialist files a claim to the patient's health insurance company. This a way of making sure that the health care providers will be able to receive the appropriate payment for the medical services that were rendered to the patient. With this process the billing specialist will also deal with unpaid claims and other problems related to related to it.

To determine the medical service that has to be billed to the company, the patient's condition and some background health information will be evaluated. Then, different codes that correspond to the procedure and diagnosis will be generated which will then be transmitted to the insurance company for the payment. But it may take from days to months for the process to be completed. This particular process is used for almost all insurance companies regardless if it's a private insurance company or if it's owned by the government.

In the past, claims were usually files using a form. The form can either be a CMS-1500 or HICF. But at present as the technology rapidly advances, the billing process is already done using such technology. Instead of sending a paper claim form, billing specialists file their claims to the concerned insurance company electronically. However, before health services are rendered to the patient by health care providers, they use a software first that will verify to the company if the patient is qualified for a particular service. Then after checking the eligibility, only then that the service can be rendered.

After submitting the claim, the insurance company will then confirm the receipt of the claim and lets the other party know that it will still be subject for further checking, reviewing and processing. And after a certain period of time, the company will then provide necessary information on whether or not the claim will be paid, the amount if it will be paid or the main reason if it will not be paid. Obviously if the claim will be paid, no further processing will be done but if it's not going to be paid, the billing specialist has to make necessary corrections basing on the reason given and resubmit the claim until it will finally be paid.

With this process, everything is definitely made faster and easier compared to manual process used before. But of course, in order to get the claim paid in a shorter period of time, the billing specialist has to know almost everything regarding the different insurance plans offered by different insurance companies. This is easier to be said than done considering that a big insurance company, alone, can offer more than 10 different insurance plans all at the same time. He/she also has to know the coverage of the plans as well as the rules and regulations related to filing claims. With all these knowledge, then the medical billing process won't as hard as you might think it is.