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Medical Billing Is an Art Form

Medical coding can be described as a form of art because:

The art of medical billing encompasses a diverse range of human activities, talents, skills, knowledge and at times emotions. Therefore this skill is a form of art. No not "paper forms" but YES! They also use standard forms. Medical billers not only review charge slips and track invoices and payments, they also analyze records to produce customized reports that show profitability or areas in need of improvement. Such reports are critical when decisions need to be made on renewing and negotiating contracts. They also advise physicians of fee structure changes, new coding practices, and ways to improve the office's bottom line. Most medical billers also handle the offices dictation transcription. This saves the medical office money and allows the healthcare providers to comply with the strict HCFA rules, which mandate clarity of all Medicare claims.

The Medical Billing Process

In a nutshell: when a physician or healthcare provider renders medical services to a patient they are entitled to be reimbursed. Collecting these moneys due is the medical biller's job. After each healthcare appointment the medical biller reviews the superbill or encounter forms attached to the patient's record to establish which services were provided. The medical biller must go through the patient's chart to compare the doctor's notes with the encounter form to verify the diagnosis codes, duration of the visit, and services rendered. Next they re-check the patient's insurance coverage and note the name of the health insurance company. Often, they also must read the patient's insurance benefit statements to make sure they are billing only for allowed procedures, deductibles, and amounts. Then they prepare proper invoices and submit the claim to a clearinghouse.

Medical Billing and Coding Industry on the Up-Swing

As the expectations and standards for proper medical coding and billing procedures become more stringent, medical billing and coding companies are rapidly becoming a vital segment of the national healthcare industry; as a matter of fact, so much so, that traditional medical staffing firms have taken note and expanded their suite of services to include physician coding and billing. Furthermore, publicly traded companies are quickly consolidating the medical billing and coding segment through the acquisition of smaller players.

  • Enjoy the healthcare field but don't like the hands-on clinical aspect
  • Understand medical language and number codes
  • Are detail oriented and meticulous when it comes to their work
  • Know the principles of the computer and how to find answers to problems
  • Like helping people but prefer to work independently away from the public's eye
  • Want to work toward becoming their own boss in a home business

 The HCFA-1500 Form

The health insurance claims are submitted to health insurance companies via the so-called . They must know appropriate responses to a variety of billing and legal situations. Bill collection, release of patient information/records, patient confidentiality rights, subpoenas, workers’ compensation rules, and Medicare regulations for reimbursement are complicated areas and must be handled competently and with care.
To get paid an Assignment of Benefits (AOB) is used, which is an authorization directing the insurer to make payment directly to the provider of benefits, rather than to the insured. The insurance carrier however, is the one who determines whether benefits are payable.

Medical billers accomplish their tasks using reference books, printed guides and references, automated office equipment, and computers with various sophisticated types of software. Software is used to file claims electronically, apply patient and EOB payments, print statements, update management reports and patient data files.

 

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