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Understanding Medical Billing, Coding, and Billing Software 2020-08-11T20:41:46+00:00

Understanding Medical Billing, Coding, and Billing Software

medical billing codesThere is a significant amount of behind the scenes work that goes into a medical practice obtaining payment for services rendered. Medical billing, coding as well as billing software are all highly relied upon by medical providers. Understanding the nitty-gritty of each of these components is not entirely necessary for everyone, but having basic knowledge of them can be helpful when dealing with insurance companies and/ or medical billing offices. 

Medical Billing Basics

Medical billing is the process of submitting a medical claim to an insurance company on behalf of a healthcare provider for services rendered as well as following up on that claim with the insurance company regarding payment. The primary job of a medical billing specialist is to ensure reimbursement for the work provided by a healthcare provider. Medical billers commonly work closely with healthcare professions to clarify diagnoses and/ or obtain additional information pertinent to the billing process. Medical billers and coders play an essential role as a connection between healthcare providers, insurance companies, and patients. 

Medical Billing Services

The duties of a medical biller will vary and depend on the specific needs of each healthcare facility. Typically, the job will include assembling all data concerning medical claims, which can include the following:

  • Reading and analyzing patient records 
  • Determining the proper codes for the patient records
  • Use codes to bill insurance companies
  • Communicate with healthcare providers to ensure documentation accuracy
  • Keep accurate account of patient data over multiple visits
  • Manage detailed, specifically-coded information
  • Maintain patient confidentiality
  • Transmit information in a secure fashion

Although the specific roles of a medical biller may differ depending on his or her location of employment, many will have to understand how to locate and/ or implement the above examples of billing specialists’ responsibilities.

Medical Coding

Medical coding is a universal alphanumeric code system for healthcare diagnosis, procedures, medical services, as well as equipment. Accurate medical coding is a crucial component needed to successfully submit a medical claim.

When a healthcare provider performs a medical service, a medical coder is responsible for assigning the proper code for services rendered. The procedure codes and diagnoses are taken directly from the medical record provided (i.e. the medical professional’s notes, laboratory results, etc.). The complexities of medical coding require a medical coder to understand physiology, anatomy, details of the services as well as the rules and regulations surrounding the services rendered. The standard code classification systems used include CPT, ICD-10-CM, and HCPCS Level II.

Billing Software

There are various billing software programs that are used by medical billing professionals. Billing software is a computer application that automates the healthcare billing process. Healthcare practices that successfully implement a billing software program can improve reimbursement rates, optimize revenue, and help in sustaining the financial health of the business. Medical billing software can also serve as a centralized platform with which to manage the entire claim processes from start to finish. Although billing software can greatly minimize potential human error and loss of pertinent information, all information input into the software must be overseen and monitored by a billing specialist. 

Further Information

As insurance regulations change, it is imperative that companies understand how each change can affect their practice, in all aspects. Insurance companies are notorious for offering excuses and utilizing loopholes to avoid paying providers what they owe. Accreditations such as CARF and JCAHO are now a common requirement for insurance companies to render payment. These certifications alert the public that a company has been adequately inspected and is considered reputable, meeting the accreditations high standards. The accreditation process can be arduous, requiring a significant amount of time and energy. Our staff offers diverse skills that enable Oracle Billing and Services, Inc. to assist in areas ranging from CARF-Accreditation, Verification of Insurance benefits, Insurance Collection Calls, Drug/Alcohol state licensing, JCAHO-Certification and more. Oracle Billing and Services has extensive experience in assisting companies in the health industry, in understanding the ever-changing regulations as well as providing expert consultation for all areas of operations. Reach out today and schedule an appointment with Oracle Billing and Services via phone at 626-872-7344. We look forward to connecting and helping to bring your company to the next level. 

Further Reading

Help Resolving Claim Disputes for Medical Billing

Finding a Medical Billing Company For Your Practice

Medical Billing for Rehabs

Ensuring Privacy in Medical Billing

The Cost of In-House Medical Billing vs. an Outside Agency

Changes to MIPS

Creating a Sliding Scale for Your Practice

Medical Billing and Telemedicine

Mental Health Professionals and Medical Billing 

Preparing Medical Billing for a New Year 

Medical Billing Tips for a New Practice

California Laws

Medical Billing and Covid-19