Medical Billing

Medical Billing and Coding

• The main purpose of medical billing is to submit and follow up on claims with health insurance companies to receive payment for medical services provided.

Role of Medical Coding

• Medical coding plays a crucial role in the medical billing process by translating diagnoses, procedures, and services into standardized codes for billing purposes.

Recipients of Coded Records

• The coded records submitted by medical billing are sent to insurance companies, Medicare, Medicaid, and other payers.

Insurance Company Review Process

• When processing a medical claim, the insurance company reviews the diagnosis, procedures, and services provided to determine coverage and payment.

Coding Systems in Medical Billing

• Commonly used coding systems in medical billing include ICD-10-CM/PCS, CPT, and HCPCS.

Steps in Medical Billing

• The medical billing process involves submitting claims, following up on pending claims, and posting payments; auditing and verifying claims is NOT a step in the medical billing process.

Purpose of Medical Coding

• The purpose of medical coding in the medical billing process is to accurately assign codes to diagnoses, procedures, and services to ensure accurate reimbursement and data analysis.

Coding Systems NOT Used in Medical Billing

• The SNOMED coding system is NOT commonly used in medical billing.

Content of Coded Records

• The coded records submitted by medical billing include patient demographics, diagnosis, procedure, and service information.

Claim Review and Verification

• The insurance company reviews the medical claim and verifies the medical necessity and coverage eligibility.