How to Do Medical Insurance Billing

Medical billing can be complex. But attention to detail significantly reduces claim denials.

Handling medical billing and processing medical insurance claims can be extremely difficult and complex. Medical billing is very detailed. If it is not done precisely, it can cause claim denials and account discrepancies. Typically, medical billing incorporates everything from handling individual patient billing and accounts to office medical receivables and statements.

Things You'll Need

• Current Procedural Terminology
• International Classification of Diseases
• Healthcare Common Procedure Coding System

Instructions

1. Start by learning medical billing codes, including the International Classification of Diseases (ICD-9 and 10 versions), the Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS).. This can be accomplished by completing a medical billing certification course, which certifies you as a medical billing specialist. It can also be done, in many cases, through experience. Many physician offices commonly offer some on the job training for medical office staff in coding and processing medical insurance claims.

2. Familiarize yourself with all types of medical billing, including processing receivables and monthly account statements.

3. Obtain the so-called "Superbill," the billing sheet that lists all the medical procedures and tests that need to be processed on a particular patient on one specific date of service. An office "Superbill" will commonly list the different CPT codes alongside the checklist of the procedures provided. However, many hospital medical billings may require coordination of an individual's charges along with the stay in question.

4. Match the CPT codes with the appropriate diagnosis codes of the patient. Pay particularly close attention to make sure the diagnosis codes coincide with the date of service that is being billed. Many times, patients will be in the emergency room for one thing and will be admitted the next day under a different diagnosis.

5. Use the appropriate medical insurance billing claims form to bill to medical insurances. Typically the form is a CMS-1500 claim form, approved by the National Uniform Claim Committee. However, some insurance company forms, such as those from the American Family Life Assurance Company of Columbus (commonly known as AFLAC), can be processed by the patient. AFLAC and other companies have their own medical billing forms that just need to be filled-out according to their specific instructions.

6. Make sure the CMS-1500 form is filled-out appropriately with patient information, insurance information and medical provider information, including the physician's national provider identifier (known as the NPI number).

7. Bill the patient for any medical charges directly if the patient has no insurance or if their insurance requires them to pay a patient deductible portion or co-pay.

8. Bill any secondary insurances with another CMS-1500 form and a copy of the primary insurance's explanation of benefits, or EOB.

Tips & Warnings

• Insurance claim mailing addresses can be found on the back of patient insurance cards.

• Medical billing can be processed either electronically or by paper copies. However, almost all healthcare systems now process medical billing electronically.

• Some medical companies will require copies of patient medical records to be sent in order to be processed. However, that will usually be requested by the insurance company after they have received the medical billing claim form.

References

• Filing a Medical Insurance Claim
• Understanding Medical Billing Codes
• Understanding Out of Network Medical Billing
• Health Insurance Claim Denials