Medical billing is a payment practice within the United States health system. The process involves a healthcare provider submitting, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly.
Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor’s or graduate degree in medical information science and technology.
Topics for this course
Medical Billing Introduction
Medical Billing Process Flow
Parties in Medical Billing
Role of a Medical Billing Company
Physicians front Office
Terminologies used in Demographics & Charge Entry
Pre – Authorization
Place of Service
Insurance Adjudication Flow Chart
Common Claim Rejections
Responsibility of a Biller
Responsibility of a Biller:
CMS 1500 Form
CMS 1500 Form
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