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Important Information about Medical Billing

Monday, December 5th, 2011

Medical billing companies are primarily responsible for the timely and complete processing of payments from both patients and insurance companies for doctor’s offices. Once a claim is filed with an insurance company, medical billing staffs are required to follow up on claims in order to make sure that money is received so that medical practices can thrive. The cycle of billing can take anywhere from a couple of days to as long as a few months. How long the cycle takes depends on how complicated the claim is and the insurance company that is being worked with.

The medical billing process starts as soon as a patient enters the office, whereby information is collected and kept up to date whenever the patient reenters the facility. The patient is then seen by the doctor and any work done is broken down into a five digit code from the CPT (Current Procedural Terminology) database. The diagnosis is then translated into a code that can be filed electronically known as the ICD-9-M database. These codes are transmitted by the Electronic Data Interchange; this is the most effective way of getting claims and payments processed as quickly and accurately as possible.

Claims are often rejected by insurance companies and the medical billing department and the process will have to start over again. If there are coding errors, those can be fixed and the claim refilled immediately. Otherwise, a patient will be sent an Explanation of Benefits sheet. Patients can always request that the insurance claim be filed again. Many insurance companies deny claims because they believe the procedure was not medically necessary. Payments for accepted claims will be received by the medical facility and the patient will be responsible for the balance of the bill. Regulations regarding these medical billing procedures have been instituted by the HIPAA (Health Insurance Portability and Accountability Act (HIPAA). Universal standards and practices are essential for an efficient and functioning medical billing system.