How Is Medical Billing Generated?

How Is Medical Billing Generated?

So, you’re not feeling well and you have tried all your home remedies and nothing is improving your illness, so you give in to go see your regular doctor.

You go to the office and give them your insurance card and wait your turn to be called. Already you’re generating work for a lot of people and you don’t even know it. Your insurance card information is pulled up and a new medical billing form is created. No matter what procedures are rendered to you today, it will be documented in the form of numbers, called CPT codes, on your medical billing form.

If you have blood drawn, a urine sample, the basic eval and once over, it will be documented on the form. If you have a bladder infection, upper respiratory illness or just a common cold, it will be documented with that numeric code on this form.

After you leave is when more jobs start. Your doctor’s staff will complete the coding from your visit on the medical billing form, and if your doctor outsources your medical billing to a third party vendor for processing, your medical billing form will be electronically transmitted via secure port to port transmission for submission to a clearing house to get your Physician’s practice reimbursed for the services that were rendered to you.

The medical billing partner will check your form for completeness, proper documentation, and correct coding and then submit your claim to the clearinghouse which routes your medical billing claim to the correct insurance company (yours) so a reimbursement can be issued to your physician’s office for the services that were provided to you that day.

This entire process can take about 2 weeks from start until reimbursement, you had no idea a common cold could generate quite so much activity behind the scenes did you?

View all Articles by: Melissa Clark, CCS-P