Definition of Medical Billing

Medical billing has been around for decades. For much of that time it was largely unregulated and unorganized, and was conducted on paper in its entirety. In view of the voluminous paperwork involved and the exhaustive number of daily medical claims, the medical billing process became tedious, lengthy and time consuming. However, medical billing in the U.S. has undergone a sea change in terms of reforms, and the induction of state-of-the-art computer technology and software. This has virtually revolutionized medical billing and has given unprecedented ease of management and control to medical practitioners and insurance companies.

Identification

Medical billing is basically an interactive process between registered medical institutions, medical practitioners or other health care providers, and legitimate insurance companies. It involves the submission and follow-up of medical claims made by the former to the latter in order to receive monetary compensation (payment). Such payment can be either toward the total or part of the costs of medical services provided by them to their patients. The vast majority of transactions involving medical billing in the U.S. are now conducted online, as opposed to on paper.

History

When it was put into practice, medical billing was conducted manually and claims took a considerable amount of time to be processed for payment. With the arrival of the computer age--and in order to meet growing demand for conducting medical billing online-several IT and software companies designed special medical billing software to cater to this potentially highly lucrative segment of the health services market.
With the enactment of the U.S. Health Insurance Portability and Accountability Act (HIPAA), the mandatory rules and restrictions in the new act compelled the IT and software companies to rebuild and redesign their medical billing software to fully comply with the HIPAA act. As a result, today all legitimate medical billing systems and transactions are conducted under full compliance with that act.

Features

There are several features inherent in a medical billing system, although such features may vary from one version of medical billing software to another or from one nature of claim to the other. However, a professional and standard medical billing software system must have the ability to deliver the following (common) features:

Ledger screens that are fully customizable;
Speedy and easy access to the individual financial and demographic details of all patients;
Full transaction control and visibility of charge balance and transaction posting;
A single platform for adjustments, charges and payments;
Web-enabled capability;
Streamlined posting of payment;
Efficient follow-up processes;
The ability to post charges, transmit claims and post payments daily, as well as to submit statements to clients monthly; and
Data security and good backup management that conform to HIPAA guidelines.

Benefits

There are several benefits from investing in a professional medical billing system. It omits the need for tedious, lengthy and time-consuming paperwork. Additionally, a reliable medical billing system makes it significantly easier to process claims; receive updated patient and financial data; and receive monthly or weekly statements. Most important, it allows for medical billing to be conducted in a swifter, transparent and more professional manner.

Warning

Medical billing also has inherent dangers that can affect its efficiency and performance, as well as the credibility of the particular medical practitioner, insurance or outsourced company involved. One area of concern to patients and health care providers is safety and confidentiality of a patient's personal and financial data.
Due to the increase in outsourcing of medical billing in recent times, medical institutions or practitioners usually face loss of control--specifically, the ability to know at any given moment the precise amount billed or collected and the amount outstanding. While it is incumbent upon insurance companies or the outsourced company to provide detailed monthly or weekly statements, more often than not this is not complied within a time-bound, transparent or comprehensively detailed manner by some of them.
While medical billing scams are more the exception than the rule, it is important to ensure the insurance or outsourced company is registered and legitimate and that it fully complies with all rules and regulations of the HIPAA act.

[tirobe6315]

on 1/12/2010 I would like to find out more information on this career. Anyone got any information?