Exactly What Is Medical Billing, Anyway?

Medical billing and coding is how healthcare providers, big and small, get paid for services rendered.

Over the past decades, medical billing has become more and more complicated. The practice of assigning this important task to a receptionist, administrator or bookkeeper has all but fallen by the wayside, with healthcare providers opting to hire specially trained personnel instead.

The reason is simple. In today’s highly litigious society, it behooves medical practitioners to make sure their medical billing and coding work is accurate and correct. Only in this manner can a lawsuit or a messy claim be avoided. The physician, hospital, or HMO can then get back to their real business: helping people get well.

The trained medical billing specialist must study basic medical terms, anatomical roots, suffixes and prefixes; anatomy and physiology; terminology and its pronunciation and abbreviations; pharmacological information, including the uses and effects of herbs and the USP Quality Review list of similar drug names; health insurance in depth, and all pertinent reference books; medical office practices including but not limited to administrative concepts and office routines, appointments scheduling, records management, transcription and preparing insurance forms…among other subjects.

One can see why this vital position has become so specialized. Usually, the same employee who carries out the medical billing also does medical coding, whether it be in-house or outsourced from a company that offers this special service. Proper understanding of medical coding requires a thorough grasp of the universal codes developed to assign exact services performed by numbers. Every single symptom, diagnosis, procedure and treatment thus are reduced to a standardized code. Without them, insurance claims are useless, and the whole system comes crashing down.

View all Articles by: Melissa Clark, CCS-P