Medical Billing

The medical expenses are claimed from the insurance companies with the help of a medical bill. Medical billing is the process of making a bill of expenses incurred by the hospitals or clinics in which you have undergone treatment. It certifies your expenses of treatment.

You can receive payment for all the services rendered by hospitals or health care center. Once the bill is submitted to the insurance company it determines the valid nature of the bill. They also look for the valid charges that you have claimed. The payment mode depends on the different plans of the companies. Some insurance companies pay 90% of the expenses while some others pay only 50-75% of the charges.

The process of medical bill though is not complicated but itÂ's not an easy task as well. The process is an interaction between the unit where you had taken treatment and the insurance company. The first step of a medical bill is to compile the medical/treatment records of the patient. This record contains demographic information, summary of treatment, nature of illness, examination details, tests conducted, medicines, surgery and other history of the patient.

All these records are evaluated well to determine the exact level of payment that will be mentioned in the bill to the insurance company. The services one determined by the staff is transformed into a five digit code recognized by Current Procedural Terminology. All sort of facts and diagnosis are converted into numerical codes that are drawn from the International Classification of Diseases, Ninth Edition, or ICD-9. Without the codes of CPT and ICD-9 the claims of medical bill is void.

After the bill is prepared, the data is transmitted for the claim to the insurance company or any other payer. This is normally done by electronic method. In some cases they are sent in paper format. Once the payer receives the bill, it processes the claims. They test the validity of the claim which includes patient's eligibility for the payment, medical necessities, and provider credentials. If the claim fails in their evaluation the payer rejects the bill.

If a medical bill is rejected the provider deciphers the message and compare it with the original claim. After scrutinizing the provider corrects the flaws and resubmits the claim again. The frequency of rejection is high due to complex nature of claims, misinterpretation of policies and data entry errors. Hence to get clearance of claims the medical claim biller and the doctors must be aware of the insurance plans and their requirements.

With the introduction of Health Insurance Portability and Accountability Act (HIPAA), the claim by medical bill has become more systematic and confidential. There is no foul play with the records of the patients. Even the electronic software companies have dedicated to prepare more sophisticated software to reduce the errors in the bills.

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