by Ania Kerekes
When you visit or call a hospital to make an appointment, a process is set into action. From your checkup to diagnosis to treatment procedures and post treatment care, all of them are taken note/are assigned codes by a medical coder. and then are sent to your insurance company by a medical biller.
In this article, you will get to know all about medical billing, the why and also how to start a career in it. Let’s get started!
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What is medical billing?
First of all let’s start by explaining terms like medical coding, claims and health insurance that you will see throughout this article.
- Medical coding. Simply means the process of assigning official codes to each stage of a medical process. For example, there is a corresponding code assigned to every injury, diagnosis, and treatment. People who do these jobs are called medical coders.
- Claims: is a document that contains information such as patients personal data, medical history; injury, diagnosis and treatment with their corresponding codes; it also contains type of insurance coverages, expenses incurred/bills from the hospital etc.
- Health insurance: it is insurance against expenses that arise from medical checkup, procedures and treatment.
Medical billing is the process by which a patient's whole medical expenses at any given time in a hospital are sent as "claims" to their insurance company by an official. This medical billing process is also called revenue cycle management.
This official is called a medical biller, and he serves as a middle person between the patient, the health care provider (doctors, physiotherapist, hospitals etc) and the health insurance company. He makes sure the health practitioner is not being owed.
Why do we bill?
We bill because the health practitioner needs to be paid for their services. Also, to make sure that the patient's not cheated by the insurance company.
What do medical billers do?
Here's a breakdown of the daily work activities of a medical biller:
- They work with patients. They collate the patient's medical record, check if they have any previous balances and factor it into the current expenses. They now send it as claims to the insurance company. If the reply from the insurance company is positive, they deduct the Medical bill from the money covered by the insurance company and send the balance to the patient to pay up. They offer explanations to patients in situations when the insurance company rejects the claim.
- They create and process claims. They also adjust them to make sure they are in line or compliant with what the insurance companies want. They ensure the claims are processed speedily.
- They're in constant communication with the patients, health practitioners and insurance companies. They're responsible for issuing Explanation of benefits, this documents list and explain the procedures covered by the insurance company and why.
- They collect any outstanding payments.
Why should I start a career in medical billing
Do you want to start a career in medical billing? Payscale reported that the average hourly wage of a medical biller ranges between $17- $27 per hour, that's good! Their annual wage ranges between $31,933 - $46,401. These wages vary from year to year. You can take up any medical billing training and certification course either online or physically. Check out sites like Coursera and Alison for start learning.
Benefits of studying medical billing
- Flexible working hours and remote work options
- Great pay
- If you have passion in healthcare but are squeamish about direct contact procedures that involve blood etc, this is a great option to be in the healthcare industry without any of that.
- Fast routes to qualification
Conclusion
Medical billing is a process that ensures that health providers are not cheated of their pay. Medical billers help make things run smoothly between the patient, the health care practitioner and insurance company. They can work in the hospital or independently.
The process of getting a certification in medical billing is not complicated and one can easily move up in that career path.
