Frequently Asked Questions about Medical Billing Services

What is meant by Medical billing?

Medical billing is a payment management process in which healthcare provider’s offices submit their claims to health insurance companies for getting payment of services provided by healthcare leaders to patients. The medical biller has a role to follow up the claim until the claim is completely settled. The medical biller ensures that data is precisely entered into the database and if a patient has any remaining balance, then it should be properly adjusted, or written off. Medical billers are the persons who take codes from the medical coding team and then send the claim to health care insurance companies to figure out how much of the amount needs to be paid by the patient and what needs to be paid by the insurance.

Is Medical Billing the Same as Medical Coding?

The answer is No. The main work of the coding team is to review the patient documents and assign the medical codes to them. The medical billing team processes and takes follow-up on claims sent to insurance providers so that they can get timely reimbursement of services provided by the healthcare professional.

What is meant by Revenue Cycle Management?

Healthcare revenue cycle management is a payment-related process that aims to manage and handle the administrative tasks linked with claims processing, payment, and settlement of claims. The process requires the identification, management, and collection of payments. Without such a process, healthcare professionals will not be able to provide excellent services or keep their doors open for patients. In simple terms, it is a strategy that healthcare organizations use to get the payments.

Why is it important to manage medical billing services?

The medical industry is constantly changing so it is challenging to maintain financial stability. Thus every health care organization requires outsourcing companies who can ensure that all the services given by the doctors/nurses or others are reimbursed. Getting their help also improves financial stability and helps in maintaining good terms with patients. Successful medical billing processes focus on front-end tasks so that claims will be paid without any rejection. Even little mistakes in claims can impact the revenue cycle and may disrupt or postpone claims reimbursement.

What are some of the challenges faced during the medical billing process?

With new healthcare regulations and changes in reimbursement models, it has become difficult for medical care organizations to smoothly go with the medical billing process. One of the issues that is faced during revenue cycle management is collection of  payments from patients at the time of or before providing service. Getting paid before the patient leaves the clinic helps save time and delays with collections. It has become more complicated as many patients even do not want to pay before availing the service or cannot afford to pay the medical bills as their deductibles have risen. Thus many medical clinics continue to struggle with so many debts.

Which providers and suppliers can be billed by using CMS-1500?

Anyone medical supplier or another non-institutional provider can use CMS-1500 for billing their services provided to patients. These providers and suppliers include clinic psychologists, social workers, ambulance services, clinic nurse specialists, registered nurse anesthetists, nurse midwives, nurse practitioners, and physician’s assistants, providers of diagnostic laboratory services, and home dialysis equipment suppliers. 

What are the procedure codes that are mostly used by physicians for providing their services?

CPT codes are used to check the most commonly used medical billing codes for treating patients. Medical evaluation and management are the codes that are frequently used that include:

• 99201-05 when a new patient visits the office
• 99281-85 when a patient visits the emergency department of the clinic
• 99241-45when a patient goes for a normal consultation
• 99211-15 when an established patient visits office

A person, who does medical billing on a daily basis, needs to have a piece of strong working knowledge about these codes.