Medical Billing FAQs
Want to learn more about the basics of medical billing? Below are some common questions and answers. Let us know if you have other questions that should be added to the list.
What is medical billing? (Sometimes referred to as Revenue Cycle Management)
What are medical billing and coding services? (Sometimes referred to as practice management services)|
What is a medical billing company?
What is medical billing software?
Does AdvantEdge offer an Electronic Medical Record?
What is Medical Billing
“Medical billing” typically refers to the process that starts after a patient is “seen”* and the physician has signed off on the “paperwork”. At this point, the information in the chart is complete and can trigger the billing, using a combination of CPT and ICD-9 / ICD-10 codes (sometimes other codes are required, e.g. HCPCS). Usually the physician or a coder in the office determines the codes. However, anesthesiologists, radiologists, pathologists, and emergency departments frequently have this work done by their third-party medical billing company. Professional billing companies, like AdvantEdge, use CPC-certified coders.
Of course, the billing process really begins well before this point. That is because patient information, referred to as “demographics” is essential to the medical billing process. This includes insurance information. Historically, the error rate of demographic information entering the billing process has been high, though this is beginning to change where practices use electronic eligibility checks and other workflow improvements.
Medical billing software
Once the “charge” (CPT, ICD, etc.) and “demographic” information enters the billing process, a claim is created and submitted to the appropriate insurance company, referred to as a “payer” or “payor”. Modern billing software, like AdvantEdge’s Virtual Manager, performs numerous edits and “scrubbing” before a claim is submitted. This reduces errors and prevents delays in collecting from the payer (insurance company). At AdvantEdge, for example, over 99% of claims are accepted by payers on the first pass.
Medical claims transactions are sometimes referred to as “EDI” since they are a class of ANSI Electronic Data Interchange standards. For instance, an initial claim filing is an “837″ and a payment is an “835″.