Medical billing is the system of putting forward and to following up on
claims with the health insurance companies so as to receive payment
for services given by a healthcare provider. This process is also used
for most of the insurance companies, private companies, or
government sponsored programs.
A medical biller is the person is responsible for all the paperwork
relating to patient records in the clinics and hospitals and physicians’
offices and nursing homes and other healthcare-related facilities. A
medical biller works jointly with the insurance companies to
administer medical bills acquired by patients, and make sure that
respective health care providers are remunerated for all services
The medical billing process is an interaction between the health care
provider and insurance company, which is the payer. This
process can range from several days to several months to
complete. This requires many interactions before an actual
resolution is reached. The health care providers are contracted
with the insurance companies to provide for the health care
For many decades, medical billing was done on paper.
However, with the arrival of
medical practice management software, known as health
information systems, it became possible to efficiently
manage large amounts of claims. There have been many
software companies that have come up to provide
medical billing software to this lucrative market. Also,
there are several companies that offer portal solutions
through their own web-interfaces, which neutralises the
cost of individually licensed software packages. Due to
the fast changing requirements by the U.S. health
insurance companies, several areas of medical billing
and medical office management have led to the
requirement for specialized training.
In recent years, the medical billing field has been challenged by the
introduction of Health Insurance Portability and Accountability Act
HIPAA consists of rules and regulations which the hospitals,
healthcare providers, doctors, and health plans should follow so as to
provide their services suitably and also make sure that there is no
breach of confidence and at the same time maintaining patient
From the year 2005, medical providers have been prodded to send
their claims electronically in compliance with HIPAA to receive their
HIPAA regulations not only affected medical billing service providers
and insurance companies, but many patients found that their
respective insurance companies and health care providers needed
additional waivers and paperwork that were related to HIPAA.
Due to these changes, software companies and medical offices had
to spend thousands of dollars on the new technology and forced to
redesign business processes and software so as to become compliant
with this new act. This was because the providers who
unintentionally released Protected Health Information to the wrong
individual, would now be liable to legal proceeding under HIPAA.
HIPAA mainly requires maintained privacy of both the patient's
personal and demographic details as well as the provider's details.
The Role of Medical Billing Service:
In many cases, particularly as a procedure grows beyond its early
capacity to handle with its own rules and regulation, the providers
outsource their medical billing process to a third party that is known
as a medical billing service. These medical billing services take a
percentage of a practice's revenues for their payment. One of the
goals of these entities is to bring down the weight of paperwork for
the medical staff and to regain lost effectiveness caused by workload
saturation, making way for further practice growth.
Medical billing rules also seem to be complex and they often change.
Keeping the staff and the billing systems up-to-date with the latest
billing rules can become a big distraction for health care providers
and the administrators. Another main objective of a medical billing
service is to use its billing mastery to focus on maximizing insurance
payments by rightly processing the provider's claims. They are singly
accountable for taking codes from the coders and providing exact
bills that are then forwarded to the insurance company. It is the job
of a medical billing professional to accomplish the billing process in a
way that it will avoid refusals from the insurance companies.
Additionally, the recent tilt in this area towards outsourcing, has
shown a capacity to reduce costs. Also, in addition, many companies
are getting ready to offer EMR, HER, and RCM to increase
customer satisfaction; however, as an industry the consumer
satisfaction levels are still very low.
Medical Billing Job Qualifications:
The medical billing field is one of the fastest growing and lucrative
areas of the health care industry. Hospitals and doctors offices are
looking out to hire professionals who meet specific qualifications
regarding health insurance knowledge and claim filing procedures with
the ability to multitask. A proficient medical billing specialist can vastly
bring down the amount of time it takes for a hospital to be
compensated for an insurance claim.
Medical Billing Certification:Although certification in the medical
billing field is voluntary, more and more employers are looking out
to employ professionals with certification since it needs less on-the-
job training. Finding a good medical billing institute that specializes
not only in medical billing training but also one that helps get a
candidate certified would be the best way to go. Successful
completion of the test will very much increase the candidate's
chances of getting employment in the medical billing field.
Computer skills are a mandatory qualification in the medical billing
field. The professionals should have expert knowledge of
proprietary billing systems so as to successfully follow the individual
claims procedures for each insurance company that the hospital or
other medical facility is looking for compensation from.
The medical billing professionals should have working facts of
government practice regarding privacy of medical records and what
part of the records may be seen by whom and under what occasion.
An understanding of HIPAA regulation is mandatory in both
shielding the hospital from accountability and also to make sure the
medical biller retains his job.
Ikyaglobal.edu is one of the leading names in providing medical
billing training and certification for students and professionals who
are interested in starting a lucrative career in medical billing.