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Medical Billing is the process of sending and following up claims to insurance companies to receive payment for services rendered by health professionals. The same process used for most insurance companies, either private companies or state owned. Medical beetles are encouraged but not required by law to be certified by taking the exam as Certified Medical Reimbursement Specialist exam (Exam CMR).
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Billing Process:
The Medical Billing process is an interaction between health professionals and insurance (paying). Health record contains very personal information: nature of illness, examination details, medication lists, diagnoses and proposed treatment. The service, once determined by qualified personnel is translated into a five-digit procedure code from current procedural terminology. The verbal diagnosis is translated into a numerical code as well, drawn from ICD-9-CM. These two codes, a CPT and ICD-9-CM is equally important for claims processing.
Electronic billing process:
A practice that has interaction with the patient is now under HIPAA send all billing requirements for services via electronic means.
Payment:
The amount paid by the insurance is known as an allowable amount. For example, a psychiatrist will charge $ 80.00 for a medication management session, the insurance may only allow $ 50.00, so a $ 30 reduction will be assessed. This is called a “provider write off” or “contractual adjustment.” When payment is made on an operator will typically receive an explanation of benefits (EOB) or Electronic Remittance Advice (ERA), along with the payout from the insurance company describes these operations.
In Medicare the physician can be either “participating” as he will receive 80% of the allowable Medicare fee and 20% will be sent to the patient or may be “nonparticipating” in which the physician will receive 80% of the fee and may bill patients for 15% or more of the prescribed amount.
