What is Medical Billing?

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According to the American Association of Professional Coders (AAPC), medical billing is the preparation, submission and follow-up of health care claims with medical insurance companies and other payers for reimbursement for services by a healthcare provider. The billing process is what transforms the payable services into a billable claim, taking into account federal and state regulations and insurance payer policies. Part of the biller’s responsibilities include following up once the claim has been sent to ensure prompt payment to keep a practice’s revenue cycle management (RCM) humming along, making a good billing team indispensable to the financial success of a practice.

What You'll Learn in this Article:

Do you need help with medical billing?

There are many steps for correctly performing medical billing and related tasks of RCM. These are often beyond the scope of smaller or newer practices with limited resources and personnel. Bikham can help practices of any size or specialty with their medical billing, follow-up and RMC.

Is medical billing the same as medical coding?

A coder’s primary task is to review a clinician’s statements and assign codes from among the standard code classification systems including CPT, ICD-10 CM and HCPCS Level II. They may need to communicate with the healthcare providers and insurance companies but as a rule do not assemble, submit and track the bill once it’s been sent to payers.

What does it mean to be credentialed?

Credentialing, also known as insurance credentialing, is the process used by insurance companies and government payers to verify and confirm the educational, competence and legal authorization to practice a branch of medicine. This usually takes several weeks to accomplish, so if a new physician is hired by a practice, the sooner application for credentialing begins, the sooner reimbursement will be paid.

Why is credentialing important?

While not a step in the billing process, insurance credentialing, especially with multiple payers, is crucial to the continued financial health of a practice, especially for newer providers.

  • It is necessary to be familiar with each insurer’s and other payers’ credentialing procedures, as they often vary.
  • Working with a medical billing company that is experienced in providing credentialing assistance with a multitude of payers is important to streamlining the process.
  • Bikham’s extensive experience with successfully assisting providers with the credentialing application process can result in faster turnarounds – and in turn, greater revenue from increased sources of reimbursement.

Revenue cycle management

Good revenue cycle management depends on continued revenue growth through the filing of numerous error-free claims with reduced and successfully appealed denials. The keys to effective revenue cycle management are an experienced team of coding and billing professionals, follow-up and reconsideration/appeals and A/R personnel – more reasons to use Bikham.

The benefits of outsourcing your billing to Bikham Healthcare

Few practices have the experienced team necessary, from medical coding and billing, tracking, A/R follow-up and related RCM tasks all under the same roof, which makes choosing a billing and practice management company so important to capturing the revenue that a practice has earned.

Bikham offers additional services to providers, including:

  • Initial billing and coding
  • Insurance verification
  • Pre-authorizations
  • Final A/R postings
  • Follow-up to insurers and patients to complete the revenue management cycle
  • Due to popular demand Bikham also added credentialing to their comprehensive medical insurance contracting services.

Steps in the medical billing process

The job of a medical biller requires not only thorough training but a keen eye for detail and the ability to successfully interact with everyone involved in the process, including providers, patients, and payers. Medical billers, as well as coders, must be able to understand the components of medical bills, including CPT®, ICD-10 CM and HCPCS level coding. They also need to be able to communicate with providers, insurance representatives, patients and others involved in the process.

Among the tasks billers perform to create and submit claims as well as receive reimbursement are:

  • Patient registration and intake.
  • Insurance verification as well as checking for pre-authorization requirements. Ideally, this should be done by the front desk at each encounter, to ensure that patients provide the most up-to-date coverage information, such as job changes and (usually) coverage.
  • Charge entry: this involves entering a provider’s clinical statements onto the billing format, while also referencing the patient’s records, and factoring in any deductibles or copays.
  • Claims transmission: today, almost all medical offices use some form of medical claims and practice management software to transmit and track claims.
  • Posting insurer and patient payments by the A/R department.
  • Perform follow-up with insurance companies and other payers, including tracking missing or delayed claims.
  • Denial management, including appeals and resubmission.
  • Follow-up with patients, as well as perform collections of past-due balances, following the best-practices debt collection guidelines.

Additional skills medical billers need include:

  • Understanding insurance carriers, and government payers such as Medicare and Medicaid, to navigate through their rules and policies to prevent delays in reimbursement.
  • The ability to successfully follow up on Accounts Receivables (A/R) including tracking denied or missing claims.
  • Use of best-practices in conducting patient relations while performing collection activities from insurers and patients, understanding of Fair Debt collection filing regulations and guidelines as well as the necessity of sending “clean” (error-free) claims in the first place.
  • The ability to interpret and prepare data and reports as indications of areas needing improvement, such as account reconciliations.

How long does it take to process a medical claim?

This can vary depending on the practice, the size and experience of its medical billing department, the kind of charges being submitted, whether additional information is necessary, such as x-rays, Certificates of Medical Necessity, referrals and other information deemed necessary by the insurance carrier or other payer, but as a rule, most claims can be processed and reimbursed in about four-to six weeks.

Who Can I Contact for Help with My Medical Billing?

Anyone needing more information can contact Bikham by phone: (718) 550-1384 as well as email: info@bikhamhealthcare.com. A Bikham representative can assist with tailoring a plan of service for any practice, regardless of size or specialty.

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