Published on January 03, 2008.
If you’ve been to a doctor, you know how crazy things can get with the billing even if you have insurance. In this article, we seek to explain how this maze of red tape works.
Simply put, medical billing involves a series of communications between a doctor’s office and a medical insurer. What is medical billing used for? As you sit atop that cold steel table awaiting your prognosis, your doctor’s office is engaging in a dialogue with your current insurance company. The topic of conversation? You, of course. As your doctor checks for all your vital signs, various medical codes are placed next to your personal medical information contained within your file.
Once your doctor leaves the examination room, your file then goes into the hands of a medical secretary, and it is sent electronically to your insurance provider using the codes mentioned above. Once your insurer has your medical information, they then begin to check your policy in order to make sure that your claim is valid. If you are covered insurance wise, your insurer will then pay the claim. If not, your medical request will be rejected.
As a matter of fact, medical claims are rejected nearly 50% of the time. In most cases, a lack of adequate communication between your doctor’s staff and the insurance company is to blame. Most of the time, a medical provider will have to contact an insurance company more than once in order to make a claim. Codes can become crossed, and medical diagnoses may be overly complicated causing a bit of a problem. What is medical billing used for when it comes to government medical programs?
Whether you have a private or governmental insurance provider, medical billing remains the same. No matter what sort of coverage you currently have, there must be some form of consultation between an insurance provider and a medical facility. It is interesting to note just how many claims are filed every day within the United States (millions), and how many people actually know what a medical claim consists of (hundreds).
Now that you are able to answer the original question (what is medical billing?), you have a better understanding of how insurance companies work. The next time that you visit your doctor’s office, think about all the different types of interactions that are occurring at that very moment. Medical billing may not be the most intriguing subject, but it does effect nearly every person that’s ever made a doctor’s appointment.