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Posted on October 1, 2010 by · Leave a Comment
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Medical billing and coding is a field that specializes in filing insurance claims to ensure payment is received for the services that were done by the health care provider. Once the claim is filed with the insurance company, the medical billing staff is to follow up on the claim to ensure proper processing. From the start of the claim until it is completed is called the billing cycle. This cycle could take anywhere from 2 or 3 days, to 2 or 3 months. The time of the billing cycle depends on the type of claim being filed and the insurance company it is being filed with.

The billing cycle begins from the moment the patient enters the medical facility. The Medical billing and coding staff collect information from the patient such as: name, address, phone number and insurance company. This information is updated every time a patient enters the doctor’s office to keep the information up to date and ensure the billing process goes smoothly.

The patient is then seen by the doctor and the extent of the visit is broken down into a 5 digit code from the Current Procedural Terminology (CPT) database. Then the diagnosis is also translated into a code from the ICD-9-CM database. Once the correct codes are determined, the claim can be filed electronically. This is done by using the Electronic Data Interchange. The claim must first be formatted as an ANSI 837 file. Filing claims electronically is the most effective way to get the claim processed and the payment received.

Often times, claims will be rejected and the medical billing and coding office will have to start the process over from the beginning. If there are errors in the coding procedure, they will be corrected and the claim will be refilled. If there are no errors detected, the patient will be sent an Explanation of Benefits (EOB). If the patient feels there is an error, they can request the claim be filed again. Insurance companies sometimes deny claims if they believe the procedure was not medically necessary.

If the claim is not rejected, payment will be sent to the medical facility in the amount the insurance company is responsible for and a notice will be sent to the patient to pay the balance if there is any. Since 2005 Medical facilities have been urged to file all claims electronically and keep up to date records on all of their patients. This is a regulation instituted by the Health Insurance Portability and Accountability Act (HIPAA). Medical billing is always changing, but it is a very important field that will always be a necessity.

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