Medical Billing

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Medical Billing

  1. 1. MEDICAL BILLING PRESENTATION ON BY ELIZABETH TOJO
  2. 2. DEFINITION MEDICAL BILLING IS A PROCESS OF SUBMISSION OF BILLS TO THE INSURANCE COMPANY IN A SPECIFIED FORMAT FOR THE SERVICE RENDERED BY THE PHYSICIAN ON THE PATIENT.
  3. 3. 3 MAIN PARTIES PATIENT PROVIDER BILLING OFFICE CLEARING HOUSE INSURANCE COMPANY
  4. 4. BILLING OFFICE
  5. 5. RESPONSIBILITIES OF A BO <ul><li>CODING </li></ul><ul><li>STRICT ADHERENCE TO THE RULES & REGULATIONS </li></ul><ul><li>OF THE INSURANCE COMPANIES </li></ul><ul><li>ASSURING HIGH PRODUCTIVITY & REIMBURSEMENT </li></ul><ul><li>FOLLOWING UP WITH THE INS CO & THE PATIENTS </li></ul><ul><li>FILING CLAIMS TO THE INSURANCE COMPANY </li></ul><ul><li>MAINTAINING PATIENT REOCRDS AND ACCOUNTS </li></ul>
  6. 6. DEPARTMENTS IN A BO <ul><li>COMPLIANCES </li></ul><ul><li>CODING </li></ul><ul><li>CHARGE ENTRY </li></ul><ul><li>PRINTING </li></ul><ul><li>PRE-VERIFICATION </li></ul><ul><li>AUDIT / QUALITY CONTROL </li></ul><ul><li>CLAIMS & TRANSMISSIONS </li></ul><ul><li>CASH POSTING </li></ul><ul><li>ACOUNTS RECEIVABLES </li></ul>
  7. 7. INSURANCE COMPANIES <ul><li>THERE ARE TWO KINDS OF INSURANCE COMPANIES. </li></ul><ul><li>THEY ARE : </li></ul><ul><li>FEDERAL INSURANCE COMPANIES </li></ul><ul><li>COMMERCIAL INSURANCE COMPANIES </li></ul>
  8. 8. FEDERAL INSURANCE COMPANIES <ul><li>GOVERNMENT INSURANCE COMPANIES </li></ul><ul><li>MOTIVE IS WELFARE </li></ul><ul><li>EXAMPLES : </li></ul><ul><li>MEDICARE </li></ul><ul><li>MEDICAID </li></ul><ul><li>CHAMPUS </li></ul><ul><li>CHAMPVA </li></ul>
  9. 9. COMMERCIAL INSURANCE COMPANIES <ul><li>PRIVATE INSURANCE COMPANIES </li></ul><ul><li>MOTIVE IS PROFIT </li></ul><ul><li>EXAMPLES: </li></ul><ul><li>AETNA </li></ul><ul><li>CIGNA </li></ul><ul><li>BCBS </li></ul>
  10. 10. THANK YOU

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