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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.

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