What Is Medical Billing?

Medical Billing is the process of submitting health insurance claims on behalf of the patient to various health insurance payors for the purpose of acquiring payment for services rendered in a medical facility.

A Medical Biller gathers several types of data to be placed on the CMS 1500 Form (physician billing) or the UB-04 Form (hospital billing).

Patient Data

The top of the CMS 1500 Form reflects the Patient Demographic Information, such as the patient’s name, address, date of birth, sex and insurance information.

Medical Data

The middle section of the CMS 1500 Form reflects the patient’s medical data, such as date of injury or illness and the diagnosis of the patient as reported by the physician.  The patient’s diagnosis is reported using a code from the ICD (International Classification of Disease) Coding Book.

Services Rendered/Charge Data

The lower section of the CMS 1500 Form reflects the services rendered by the physician as well as the monetary charge associated with each service provided.  The services rendered are reported using codes from the CPT (Current Procedural Terminology) Coding Book.

Revenue Cycle Management

In addition to gathering data and submitting the insurance claim form to payors, it is the responsibility of the Medical Biller to ensure that the data is accurate and that the claim is adjudicated properly.  Payments coming from either the patient or the insurance payor are posted to the claim by the Medical Biller.  Any remaining balances are then either written off, adjusted or pursued in collections.

Certified Medical Billing Professional Certification & HIPAA Certification