Medical billing: the financial side of the medical industry explored



We all know about the medical sector and the everyday things we see as members of the public. From ambulances racing past, to GP appointments and hospital wards, we get to experience much of the healthcare sector first-hand. When you begin to dig deeper though, you start to realize that there are a whole load of things going on that you didn’t even think about!

This could be the sheer variety of roles that can be found within this sector, the digital infrastructure that hospitals have, or even the financial side of the industry. It is details like this that are fascinating to look into further and give a more thorough understanding of what happens in the background. Medical billing is a classic example of this and certainly merits more attention.

A great career choice

One of the first things you might want to know about medical billing is that it is a good job to get into. The process of medical billing is simply a number of steps that are taken by providers to reimburse medical professionals for services rendered. The people who do this are known as medical billers and are often in great demand due to the key nature of what they do. Not only that, but working in this job also allows you to access one of the best healthcare roles without needing to go to medical school. While specialist qualifications are needed, they often take a lot less time to complete than training to be a doctor or nurse. When you also add in the attractive salary and job satisfaction, it is a good career to follow.

Get an idea of what is involved 

As noted above, medical billing is connected to the financial side of the whole healthcare industry. As such, the process that medical billers follow when completing their work is usually laid out for them. A medical biller would have to learn each step of the process and then follow these medical billing process steps when working.

But what are these steps? The first port of call in most cases is patient registration. This sees basic patient information collected along with relevant insurance details. The insurance details are then verified by the biller and a file is set up for that particular patient. The next action is to work out who is financially responsible for any treatment or attention. If the insurance plan in place does not cover the medical care given, then the patient will be notified of this and reminded that they will have to pay themselves.

A superbill is created

When checking in, the patient will be asked to fill in relevant forms for their file by the biller. After the patient has gone, the medical report is turned into procedure and diagnosis codes by a medical coder. After this, a report called a superbill is created, which contains all the information collected on the patient so far. This superbill is then passed to the medical biller, who will use it to create a claim to be submitted to the given insurance provider. It is also the medical biller’s job to check this claim carefully for accuracy. Once the claim is deemed to be correct, it is then electronically transferred to the insurer for them to settle the bill.  

Claims are adjudicated 

Once the insurance company has the claim, they will do their own checks to ensure that it is correct. At this point, they could choose to accept, reject or deny it. Accepted claims are paid, while denied ones will not be. Rejected claims go back to the medical biller to look at, as this is the insurer saying that it has errors on it. A statement will also be prepared for the patient at this stage to invoice them for any monies they owe. Medical billers will do this and also keep an eye on anyone who does not pay. 

It’s not all doctors and nurses

What the above shows is that there are a great many roles within healthcare that are not doctors or nurses. Jobs such as medical billing are key to how the US medical sector operates and play an essential role in its effectiveness. In essence, it helps to keep the financial side of healthcare in check. If you are thinking of working in this sector but want an alternative role to consider, then medical billing could be a smart move. Not only will this role always be in demand, but it also has a decent salary and great job satisfaction to boot.