A Beginner’s Guide to Medical Billing Services

As health practitioners are well aware, the billing process is an essential phase in managing a successful practice. However, in an industry as complex as medicine which is built upon insurance filings, complex coding, government regulations, and strict reporting procedures billing can be a very complicated and time consuming process. As a result, medical billing has blossomed into its own industry, with medical billing companies offering their services to independent practitioners, group practices, health care facilities, and hospitals. While medical billing professionals are not required to be certified, most choose to take on certification through programs like the Certified Medical Reimbursement Specialist (CMRS) exam and the Registered Health Information Administrator (RHIA) exam.

Medical billing services are also more important now than ever before because of the movement toward electronic services and paperless billing. In addition to understanding coding procedures and filing policies, medical billers must often be able to handle sophisticated software in order to file claims effectively and bill customers efficiently. The billing process requires the billing service to communicate with the provider of the health care services as well as with an insurance company, known as the payer. This process is sometimes referred to as the revenue cycle management (RCM). Time is of the essence during RCM, as the process can be very lengthy, ranging from days to months to complete successfully in order to ensure that the practitioner is reimbursed for their services by the insurance company.

Doctors must first assign codes related to the diagnosis of the patient as well as codes related to the methods and procedures used to treat the patient to the individual file. The codes are used by the payer to determine whether or not the practitioner is eligible for reimbursement, based on the patient’s coverage, and how much reimbursement the practitioner is eligible for. Mistakes made at this stage can delay payment significantly, and comprehensive knowledge of the different codes required is a must. Few practices can afford to hire an in house medical biller to handle their filing; if they can, a single biller may find it difficult to handle filing for an office in the timely and efficient manner that a medical billing service can.

In addition to understanding the billing process and required codes, medical billing services also utilize special software platforms to streamline both the billing process and the process of the practitioner entering information. These platforms can streamline workflow at the clinical site, minimize mistakes, and speed up reimbursement. They also reduce the chance that reimbursement will be denied, and often back up information related to claims to the cloud, where it is managed by the medical billing service. This allows medical professionals to focus on what they’re most qualified to do, which is treat patients. It leaves the very specialized skills of medical billing in the capable hands of medical billing services which employ certified, qualified individuals that understand how to use the system most effectively for the best results.

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