Medical Billing – Beginning With the Basics

It starts with a patient who sees a physician. The patient gives the office their insurance or Medicare card and a new medical billing form is generated. No matter what procedures are rendered to the patient, it will be documented in the form of numbers called CPT codes, on the medical billing form.

If the patient has any testing done such as a blood or urine sample, basic evaluation or even a patient history interview, all of this including if the patient is a first time visit or not will be documented on the medical billing form. If there is a reason for the patient not feeling well such as the flu or a bladder infection, it will be documented on the medical billing form in numeric code.

When the patient leaves, there is still more to do. The doctor’s staff will complete the coding for the procedures done for the patient and then they will send the form to a third party vendor for processing.

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

This entire process can take about 2 weeks from start until reimbursement, now you know how much documentation each and every doctor’s visit can generate and you know why accurate medical billing is so important!

View all Articles by: Kathryn Etienne, CCS-P