Skip to main content

Medical Billing System



The medical billing system is a complex system of codes and electronic records. Often, the job of the medical billing system professional is reduced to nothing more than sorting through paperwork by people who want to make you think that it's easy being in this sort of business. We'll tell you now: It is not.

There are actually two kinds of professions involved in medical billing systems. These are the medical coders and the medical billing agents. Although the jobs of each are distinctly related to each other, their functions to the medical billing system are actually quite different.

While medical coders are in charge of converting all types of healthcare-related encounters, such as services, tests, treatments, supplies, and procedures, into a set of numbers, the medical billing agent uses this coding system to match their claims. Medical billing system therefore is a combination of both medical coding and medical claims processing.

Medical Billing System: The Coding Process

Doctors would be quick to say that they'd rather collect payment from their patients right after the office visit or hospital stay. But the thing is it's an unrealistic notion. Majority of their patients have health insurance and in order for doctors to get reimbursed fees for medical services rendered, they must first process it by filing a claim with the patient's health insurance providers, managed care organizations, or government entities. To a doctor, this is just another headache on the list.

Medical billing system makes it so much easier. During the coding process, the job of the medical coder is to convert the notes written into patient's medical records by doctors or physicians, or other healthcare providers. These notes often describe what type of treatment was provided for the patient. It is part of the medical billing system to convert these notes into alphanumeric codes, the language used by insurance providers in processing your claims.

There are over 10,000 codes available and the medical coder has to choose the right combination of codes in order to correctly file a claim.

Medical Billing System: The Biller's Work

While choosing the correct diagnostic and procedure codes are in the hands of the medical coder, the other aspect of medical billing system which is making decisions to achieve optimal reimbursements falls under the responsibility of the medical biller.

A medical biller can often be likened to a medical practice's income manager. He is trained to understand how the medical billing system industry works, especially when it involves health insurances. Thus, the medical biller will have to know about basic and major medical coverage plans, such as the Fee-for-Service Plans, Health Maintenance Organizations (HMOs), and the like.

Popular posts from this blog

Medical Billing Careers

Medical billing careers are among the top contenders of the recent job explosion in the healthcare industry. In fact, the Bureau of Labor Statistics states that it is one of the top twenty occupations in healthcare. Medical billing careers are pivotal to the success of the medical practice. It is often referred to as the doctor's key to getting paid for the services he rendered. Medical billing careers encompass a wide scope and a broad range of responsibilities as it includes front office tasks, among others, in its list of things to do. Nature of Work Success in medical billing careers is not as easy as it is often made out to be by those ads you see in the classified section of the local newspaper or the Internet. Not everyone who enters into one end up rich. Competition is fierce and in the end, the competent ones are the only ones who survive. To achieve some measure of success in medical billing careers, you will need to know all the basic concepts related to the jo...

Billing Insurance Medical Software

The process of selecting billing insurance medical software for a medical office or clinic can be overwhelming and time-consuming. There are just too many billing insurance medical software packages available out there; it's hard to make up your mind. In addition, compliance to strict guidelines regarding the privacy and security of patient records and information is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). That makes it even harder to find a billing insurance medical software program that hits every aspect of the target. Finding the right type of billing insurance medical software can spell the difference between a good service and a bad one. In fact, the type of billing insurance medical software used in an office or clinic can greatly influence its bottom line. Its effect even embraces such things as business efficiency and employee turnover. There are also hidden costs to billing insurance medical software and they can often...

Medical Insurance Billing Software

Medical insurance billing software has been helping medical practices manage their offices for decades now. In fact, the earliest medical insurance billing software, though somewhat primitive then, started appearing thirty years ago, give or take a few years. One can even say that medical insurance billing software is about as old as medical billing itself. The medical insurance billing software packages today are called medical practice management systems or MPM systems and they bear only the most basic resemblance to their older counterparts. These packages are often packed with features to make medical billing easier and simpler for the medical biller and coder. The uses of medical insurance billing software may vary depending according to the type of features the package contains. Some solutions may allow staffers to track patient demographics, visits, and diagnoses. Others may collect, transmit, and track billing information and insurance payments. Still others apply mor...