What You Need To Know About Medical Billing Services

Medical billing is a bill payment method within the United States healthcare system. The process typically involves a health care provider submitting claims for payment of services rendered to a patient; including tests, procedures, and treatments; to obtain payment for medical services rendered by a health care provider. In order to be licensed as a physician, it is required that he or she also complete and pass an education and training program which typically last from one to three years; consisting of both classroom lecture material and clinical experience. It is also required that all medical billing specialists, along with their assistants, be registered with the American Health Information Management Association (AHIMA).

Along with a doctor’s training and education, all medical billing specialists and their assistants must pass an examination given by the American Health Information Management Association; and this exam is known as the AHIMA Billing Examination. Passing this exam qualifies the individual to participate in the Medical Coding & Billing Association of America (Macular Language Association of America) Medical Billing Exam. Each State has its own examination schedule; as well as different qualifying scores for the exams. Once the individual passes the examination, he or she will become a certified medical billing and coding specialist.

During a patient encounter with a physician, the first thing that takes place is a complete Medical billing and coding encounter. During this encounter, the doctor requests basic information from the patient about his or her health history, symptoms, medical history, prescription medications, healthcare providers, etc. Based upon the information the doctor has gathered, the physician will assign a code number to help organize the patient’s medical information and subsequently generate a claim for payment.

It is at this point where the role of the medical billers and coders comes into play. The biller or coder then parses these data to identify what provider(s) provide the best possible care to the patient and which ones would need additional treatment due to the coding errors. As previously mentioned, each State has its own set of rules for assigning codes. For instance, in Massachusetts, all physicians and medical bills are required to complete a three-year degree. This ensures that all providers are educated on the standards used to assign codes and how to deal with patient collections in case there are non-payment issues. As a result, the number of non-payment cases stemming from incorrect coding has significantly decreased.

In order to ensure compliance with all state codes, all physician practices need to be inspected and certified by third-party groups, such as the American Health Information Management Association. At the inspected facility, medical billers and coders sit on a panel and are subjected to rigorous training in HIPAA compliance. Once certified, these individuals are allowed to work for their designated healthcare providers. The certification also serves as proof that the physician practices follow all guidelines and standards set forth by the United States Health Information Management Association (HIPAA).

Physicians who are not certified in HIPAA compliance may still use third-party companies to perform medical billing services for them. However, many experts recommend against this practice because it can open the door for abuse by clinics and health care providers who don’t follow all regulations. For instance, a healthcare management provider may submit inaccurate, fake information or even change information without going through HIPAA standards. When a provider uses a third-party service, he or she must provide written permission before using the services. This gives patients and other stakeholders as a way of tracking and monitoring healthcare practices to make sure they are following all regulations and procedures.

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