For many patients, little thought is given to medical bills beyond paying them on time or referring them to the insurance company. Most people believe that medical billing and coding is little more than printing an invoice and sending it on to the patient for payment, but this is not the case. Because the process is more complicated than it seems, many medical professionals use external medical billing resources to complete their billing procedures.
While each health care facility has its own process, medical coding and billing procedures often follow the same path from business to patient. First, the patient receives treatment or is examined by their physician. The doctor takes extensive notes regarding the visit, or records a summary to be transcribed.
Once the notes have been transcribed, unique medical codes are assigned for each test, medication, procedure, and diagnosis. There are two main types of codes: International Classification of Diseases (ICD) and Current Procedural Terminology (CPT). ICD codes often utilize a decimal point, and represent diagnoses and inpatient procedures, while CPT codes represent outpatient procedures and services, and have no decimal point. The codes are then used to prepare a claim, which is sent to the billing services provider.
Physicians often utilize third-party medical billing resources as the paperwork for medical claims can be complicated. If the codes for services, patient number, or rates being charged are incorrect or do not match, the claim can be denied. This results in the patient being forced to pay the entire bill, or being denied insurance or care.
Properly documented medical codes and bills protect patients from unfair prosecution and ensure that the physicians are paid for their services in a timely manner. By utilizing specialized medical billing resources, medical facilities can be positive that the information is correct and that they will receive necessary payments on time.