HEALTHCARE CODING & BILLING INSTITUTE
Medical Billing
The billing process starts with an encounter between a patient and his healthcare provider. The provider documents this encounter in a medical record. Whatever happens during this encounter will be the basis for the services billed.
The patient’s record is processed by a medical coder. Diagnoses and procedures documented by the provider in the record will be translated into alphanumeric codes from ICD-9-CM, CPT-4, and HCPCS
The patient’s bill is processed by a medical biller. Codes are entered into the necessary forms for submission to the concerned agencies, such as private insurers, Medicare/Medicaid, or their authorized vendors.
Insurers process the physician office’s claim and assess whether the claims are valid or not. Valid claims are reimbursed according to how the physician’s office billed the services, which ultimately are the product of the coder’s work.
Denied claims are not reimbursed, in which case the patient can file an appeal.
