Medical billers and coders work for medical billing company to ensure patient, that insurance billing in medical and hospital facilities are well handled. The medical billing offers a common language between private insurance companies and health care facilities. To prevent medical facilities from failing to receive the required reimbursement for their services, there must be proper billing and coding. Below are some essential duties of medical billers in medical billing company.
Duties of Medical Billers
1. Current Procedural Codes
Every test and procedure undertaken in the medical facility contain its code or procedural terminology code that is well recognized. Specialists under medical coding and billing will review a patient’s chart then create several services that are offered. The CPT code will then be placed onto an insurance claim form. The reimbursement amount is determined by the insurance company with the set system.
2. Diagnosis Codes
Medical billers do assign some alphanumerical codes onto every disease, injury, and patient’s medical diagnosis. A medical coder will then select a system which matches the patient’s diagnosis that has been supplied with his/her physician together with the diagnosed results tests in the medical chart of the patient. Here, the diagnosis code is matched with a CPT code.
3. Billing Insurance Companies
Medical billers make sure they complete an insurance claim forms needed for medical facilities. By completing the form, they include information of the patient, which include; policy number, name, and date of birth. There are also other ICD-9, and CPT codes added where every ICD code has its corresponding CPT code, which is as per the requirement of the insurance company for necessities of paying medical bills.
4. Patient Billing
After spending the allowed amount from the insurance company where the physician gets to discount medical bills according to their agreement with an insurance company, then the patient can owe deductible or copay. The medical biller will then create a statement then mail to a patient when needed since they handle the payment arrangements and patients’ agreements.
5. Payment Processing
The medical biller needs to have a comprehensive understanding concerning various contract and plans of different insurance companies. One provider may tend to several various agreements which contain the same single carrier for insurance where they might have different covered services, schedules, as well as the rules. Here, the
physician always has to charge more concerning the procedures compared to what an insurance payer has contracted. The insurance company is then able to pay the allowable amount.
6. Coinsurance, Copays, And Deductibles
Most of the available insurance plans do need the patient to be able to share their costs using the deductibles, copays, or the insurances. For instance, a case where the allowable insurance amount is $100, when the patient gets to have a copy of $30, automatically the insurance company will make the payment of $70. Here, the patient will be needed to pay directly an amount of $30 to the physician, especially when he/she is receiving the services.
The above are some of what the medical billers and coders do. To be precise, the medical billing company will always look for qualified people who can help them accomplish the above duties in time so that they won’t delay payments from the insurance companies.