What Is: Medical Billing?
Medical billing is the process of compiling, coding, submitting and following up on medical claims to both private insurance companies and government insurance programs to secure payment for services rendered by various medical professionals. The medical provider (payee) contracts with the insurance company (payer) to provide health care services, which must be extensively documented before a claim will be paid. Medical billers take the patient's medical record, including demographic and insurance information, reason for visit, diagnosis, and list of procedures or treatments performed, and translate these into two five-digit codes known as CPT (procedure code) and ICD-9-CM (diagnosis code). The biller than transmits the patient's information and billing codes as a claim to the insurance company, where it will be reviewed by medical claims examiners or adjusters in a process that may take anywhere from a few days to many months, depending upon the accuracy of data provided, the complexity of the claim, and the fact that the insurance company and medical provider are generally at cross-purposes, with one desiring maximum reimbursement and the other preferring to minimize payments.
