Medical Office Billing Procedures

Procedures

Medical office billing procedures follow a standardized formula that utilizes a set of billing codes that are recognized by insurance companies. The billing procedures begin when a patient first registers with a health care facility. A form with the basic codes listed beside office procedures is attached to the patient's chart. The initial chart holds listings for taking a medical history, examining the patient, taking blood samples and simple office treatments. After the doctor sees the patient, or any procedure is completed, the health care provider checks off the box corresponding to the services she provided. The patient exits the doctor's office or is transferred to a hospital bed or other part of the facility, and the chart moves to the payment office. There the codes are checked against the procedures and entered into the billing software used by the facility. A bill is generated and sent to the insurance company.

Payments

Health care providers typically receive payments from insurance companies within 30 days of filing a claim, and the balance not covered is billed to the patient. Doctors learn which insurance companies pay on a timely basis and often choose not to accept insurance from those companies that take 60 to 90 days to pay claims. A software program tracks those payments, allowing providers to decide which insurers they continue to work with. As benefits and payment schedules change, a medical billing program can adjust, showing the billing office what to expect from the insurance company. Medical billing offices may require the patient to pay the bill and request reimbursement from the insurance company.

Coding

Although the basic codes are on a patient's chart, they must be verified and entered into a computer by a medical coding specialist. Most coding professionals have gone through certification training and have learned to recognize medical terminology and the basic coding structures. They must be very accurate when entering the codes into the system, as one misplaced number can delay payment from an insurance company or over-bill a patient. Medical coders also must be proficient in reading doctors', nurses' and lab and x-ray technicians' notes in order to complete billing procedures for complicated treatments and surgeries. In the medical coding training programs, students also learn how to utilize the most current software systems to manage patient files, insurance payments and billing forms. They learn how to recognize various coverage levels and to understand government insurance programs, such as Medicare and Medicaid, which employ their own coding systems.

Integration

Medical coding and billing software is integrated with patient records and files. All of a patient's insurance information, previous visits and other medical history are kept in one place for easy access. Medical billing software can be set to automatically generate bills to patients when an insurance company doesn't pay the full amount and follow up after a certain date when payment is not received. Another bill is generated to the patient requesting payment for the portion not paid by the insurer. Future appointments, followup procedures, copies of prescriptions and receipts all are managed in a single patient file with the newest medical office software platforms.

Resources

• American Academy of Professional Coders