Medical billing
Medical Billing
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.
Pronunciation
Med-i-cal Bill-ing
Etymology
The term "Medical billing" is derived from the words "medical", which is related to the science of medicine, and "billing", which refers to the total amount of money owed for goods or services.
Related Terms
- Healthcare provider: A person or company that provides a healthcare service to you. In other words, your healthcare provider is the person or place that is providing you with medical care.
- Health insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the insured.
- Claim: A formal request to an insurance company asking for a payment based on the terms of the insurance policy.
- Procedure: A series of actions conducted in a certain order or manner.
- Treatment: The management and care of a patient to combat disease or disorder.
Process
The medical billing process is an interaction between a healthcare provider and the insurance company (payer). This billing process can also be outsourced to a third-party medical billing company. The entire procedure involves several steps including the registration, establishment of financial responsibility for the visit, patient check-in and check-out, coding of services, and billing.
Related Terms
- Registration: The process of recording information about a patient and their medical history before or at the start of the patient's visit.
- Financial responsibility: The obligation to pay for healthcare services. This can be determined by the patient's insurance coverage or lack thereof.
- Medical coding: The transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes.
- Third-party medical billing company: A company that takes over the medical billing process from healthcare providers.
Challenges
Medical billing can be a demanding and challenging process for small medical practices and large hospitals alike. These challenges can include training and managing staff, ensuring compliance with regulations, handling patient data, managing denials and rejections, and staying updated with the latest industry changes.
Related Terms
- Compliance: Adhering to laws, regulations, guidelines, and specifications relevant to its business processes.
- Denials and rejections: These are terms used when a claim is not processed by the insurance company. A denial is when the claim is processed and deemed unpayable, a rejection is when the claim is not processed due to issues found before the claim processing.
- Patient data: Information about a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results.
External links
- Medical encyclopedia article on Medical billing
- Wikipedia's article - Medical billing
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