Medical Billing Explained

If you’re researching becoming a medical biller, it is a fantastic career with a great future. Basically a medical biller takes the documentation provided by their client (a doctor or hospital) that has rendered services to a patient and is looking to get reimbursement for those procedures and services from the patient’s insurance company.

The medical biller’s job is to submit the claim to the carrier (insurance company) and get their client (the doctor or hospital) a reimbursement. The medical biller will have to make sure the claim is properly coded. This means that each procedure and service has a numerical code assigned to it. Those codes must be logical and necessary. The medical biller will make sure the underlying disease, diagnosis, and services rendered are completely translated into a form to be submitted to the carrier.

The form will be reviewed and checked for accuracy and completeness of documentation and then submitted electronically to the carrier, usually through a clearinghouse for reimbursement.

If a claim is only partially paid or rejected by the carrier, a medical biller will step up to the plate for that scenario as well. Medical billers will challenge rejections and denials and attempt to get their clients not only the maximum reimbursements but payment on rejected claims as well.

A medical biller will use the HCFA-2500 form which is the universal form used to submit health insurance claims to many carriers. Medicare has a different set of rules for reimbursements and a medical biller will need to be well versed in that aspect as well.

Staying up to date on the fast changes in the industry is a must for being the best medical biller you can be. If you entering the field, you will find medical billing is both a challenging and rewarding business!

View all Articles by: Melissa Clark, CCS-P