The medical coding and billing process is a part of the medical industry that is now so complex, that colleges actually offer courses in this topic!
Medical billing in America is almost always a lengthy and stressful process now. First, your diagnosis and treatment records are submitted by the care provider to a medical biller. The medical biller then creates a billing record and submits it to an intermediary source, who edits your billing claim to meet insurance company criteria.
Next, the intermediary sends your medical bill to the insurance company to process the payment, and it is here where many problems occur.
And they happen at this particular stage of the billing process because the insurance company will conduct a series of “tests” on your bill to determine whether or not they will pay the claim. These tests include determining the patient’s eligibility for payment, the credentials of the provider, and the necessity for medical assistance in your case.
And believe it or not, sometimes the determination of whether your bill gets paid, and how much the provider is allowed to charge, depends greatly on the [Read more...]