Medical Insurance Billing and Coding

2007-10-19 12:18:07

( Pharmeceutical-Medical )



An Overview of Medical Insurance

The health care industry is constantly changing in outlook and policy. Before a hospital or clinic can bill a patient, it has to determine the correct amount to charge. It is often the exception rather than the rule that patients will pay for the entire amount of the medical bill, because patients are usually enrolled under government-subsidized or private health care insurance programs.

If the patient has private health insurance, the computation of his medical bill becomes even more complicated. This is because medical insurance coverage varies per patient. Set-up of services and billing are different among insurance companies, and depends on other factors.

For instance, billing for a physical examination is different between a health maintenance organization and an indemnity type. Under the HMO, you may be paying lower fees than with the indemnity plan. On the other hand, it will also depend on whether the doctor you were consulting was part of a network or not.

Duties of a Medical Billing Coder

At first, it may seem that a medical insurance billing and coding specialist's job description is mainly clerical. This is partly true, but is not the only thing involved in the job. As a medical billing specialist, you actually have very intricate functions which need special training.

Every time a patient consults and receives medical services, you need to verify his health care coverage. Then you need to determine the exact amount of co-payment the patient needs to make, and which portion is to be claimed from his insurance provider.

Most medical billing specialists also perform record-keeping functions. This needs to be carefully done, as medical records are crucial for future reference.
You need to keep a tab on any outstanding or unsettled bills that the patient still owes, and you have to follow them up accordingly. You also need to follow up with medical insurance companies regarding the status of your clinic or hospital's claim. Failure to do so can cause serious financial and operational problems.

Requirements for the Medical Insurance Billing and Coding Field

The job is in high demand, especially for medical insurance billing and coding specialists who have had training, certification and experience.

You need to take up about two years' worth of training at a local school or training center. You can also take medical coding courses online, though this is more recommended only after you have finished the basic course.

Once you have completed the course, you can take the certification test. While some institutions do not require certified medical billing coders, it will still give you a definite advantage and greater opportunity in landing the job.


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