What are Medical Billers?
Medical Billers submit insurance claims on behalf of patients to various health insurance companies for the purpose of taking payment for services provided in a healthcare facility.
The main job of a medical biller is to:
1. Understand each patient’s responsibility for payment, as payment may vary from customer to customer.
2. Take stock of, and closely inspect insurance coverage and medical charges, and prepare accurate billing statements.
3. Acquire accurate payout from insurance plans and/or individual patients.
What is the health insurance claim cycle?
This is the process a health insurance claim goes through from the time it’s submitted by the provider, until it’s paid for by the carrier. The claims process can be summed up as the interaction between the health insurance providers and medical insurance companies.
How does the health insurance claim cycle work?
There are four parts to the lifespan of an insurance claim: submission, processing, adjudication and payment (or refusal/denial).
Submission occurs when the claim is transmitted to the insurance carrier.
Processing is completed by the payer by collecting information about the patient, provider, and services performed from the insurance claim form.
Adjudication takes place after a medical claim is submitted. From there, the insurance company decides their financial responsibility for the payment to the provider. The insurance company makes a choice on whether or not to deny the claim outright, pay the claim entirely, or reduce the amount paid to the provider.
The last step in the process is acceptance or denial of the claim in which the claim is dismissed by the insurance company, or some amount (if not all) is paid to the carrier.
How are medical billers involved?
Medical billers submit the initial payment to start the process. Medical billers are also responsible for the accuracy of claims and to make sure that claims are adjudicated as they should be. From the time the patient checks in, until final bill collection, medical billers are responsible for the gathering, recording and transmission of information. Medical billers, therefore, are a vital part of the health insurance process.
In order to learn more about this process, and where you would fit in as a medical biller, sign-up for our P1 Medical Billing Course with CMBP & HIPAA Certification.