Medical Billing Compliance For Beginners

What is medical billing?  Medical billing is the process where the provider of services, a physician, hospital, or clinic, submits information to various payers to pay for the services rendered. There are lots of codes used that describe the diagnosis and the treatment. Once the codes are calculated, the insurance forms are transmitted digitally. The payer then reviews the information submitted and determines whether it is service covered by the patient’s insurance plan, and they then calculate how much they will pay. In the office, the billers are responsible to collect any co-payments.

To help ensure accuracy with the process, medical compliance was initiated by CMA which handles Medicare and Medicaid. While accurate documentation of a patient’s health history and treatment is important, clinics and their physicians should be able to rely on staff to do the paperwork and be able to focus on patient care.

Efficient medical billing staff allows the physician to be more effective at what s/he is trained to do. The staff keeps the clinic profitable by making sure all services are well documented, that claims are sent out timely, done accurately, making sure that the payer will find no reason not to pay. Then they track all of the elements related to the payments process and monitor late payments.