How Does Medical Billing Work?

Basics

Medical billing uses billing codes to identify procedures, diagnoses and treatments. Medical coding software translates doctors' notes into the proper codes for insurance billing purposes. While the software can save time for billing departments required to fill out the insurance forms, doctors and nurses scribble orders and check off procedures on forms that must be checked and verified by medical coding professionals. Medical billing coders must pay close attention to the boxes checked by the service providers to receive the correct reimbursement from the insurers. Web-based medical coding platforms, which most healthcare providers use, can search databases for drug and procedure references and put in the proper coding for various geographic locations and specialties.

Coding Professionals

Codes must be verified and entered into a computer by medical coding specialists. Most coding professionals have gone through certification training and have learned to recognize medical terminology and the basic coding structures. Training to provide medical billing services is available through most community colleges and a number of online organizations. Medical billing coders must be proficient in reading doctor's, nurses' and lab and x-ray technicians' notes in order to complete billing procedures for complicated treatments and surgeries. Medical coding training programs instruct students in 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. Special medical coding software to find the correct codes for Medicare and Medicaid reimbursement is also available.

Patient Files

Medical coding and billing software is integrated with patient records and files. The files are created when the patients first register with the provider. A front desk clerk attaches a form with the basic medical billing codes listed to the patients' chart. The initial chart features sections for medical history, examining the patient, taking blood samples and simple office treatments. After the doctor sees the patients, or any procedure is completed, the healthcare provider checks off the box corresponding with the services she provided. A medical billing coder checks the procedures and enters the codes into the billing software used by the facility. A bill is generated and sent to the insurance companies. Billing files stay with the entire patient file to form one record, which then can travel with the patient to other providers and within a healthcare facility.

Resources

• Federal Trade Commission