Healthcare Billing Explained

Patients’ insurance claims and bills are created using medical billing and coding codes generated from this process. This is often referred to as Revenue Cycle Management. Patient registration and financial responsibility verification are critical to the accuracy of medical billing claims. Both healthcare billing and medical coding support and create the foundation for revenue cycle management, providing cash flow for medical practices and hospitals.

Revenue Cycle Management (RCM)

In order for a clinical practice or hospital to be reimbursed, proper and effective medical billing is absolutely essential. Medical offices and hospitals would be unable to generate revenue from patient treatment without a good healthcare billing process. Healthcare services’ revenue cycle starts with hospital billing and coding. Bad billing and coding results in denied claims can slow down collection and reimbursement and has a negative impact on the revenue cycle . The revenue cycle of healthcare services is based on the administration of all things medical billing, coding, and collections/payments receivables.

An Overview of the Elements of hospital Billing

In the majority of cases, medical billers are tasked with four things:

  • It is up to the medical coders and billlers to add the charges of any medical operation or service given before a bill can be generated.
  • After a hospital bill is prepared, the medical biller produces and processes a medical claim for payment.
  • Communication with third parties: The medical biller maintains constant contact with insurance companies and other healthcare stakeholders to ensure a seamless workflow. It is the medical biller’s job to ensure that all parties engaged in the billing process are on the same page from start to finish.
  • As a medical biller, you are also responsible for contacting and arranging collections for patients who have not paid their medical bills.

The revenue cycle of any healthcare system is dependent on these four components of billing.