Medical Billing & Coding

The job of a Medical Billing and Coding Specialist is to read your chart, match up what was wrong with you with its corresponding numerical code from the most current ICD-10 book, and then assigns the proper diagnosis code with its numerical code from the CPT 4 book. Those two codes and any modifier codes that may need to be used to better describe your problem and its treatment are then placed onto a patient encounter form or superbill.

This patient encounter form or superbill is then given to a Medical Biller or Medical Billing Specialist, as they are known in the industry, The Medical Biller or Medical Billing Specialist then inputs the information provided by the Medical Coder into whatever software package is used by the practice exactly as it is written. That information is recorded onto either a CMS 1500, UB-04 or ADA form. The information is then electronically submitted directly to the patient’s insurance carrier or sent directly to an electronic clearinghouse. When neither of those options is available, the form is printed out and mailed to the appropriate insurance carrier. If there is no software program available, the claim will be handwritten onto a CMS 1500, UB 04, or ADA form and mailed to the appropriate insurance company for processing.

However, a medical billing specialist’s responsibility does not end there. Once the information is submitted, the medical billing specialist then must follow up on every claim to make sure that it is paid. Sometimes that can be a burden because they must spend a lot of time on the phone with insurance carriers trying to get information about specific claims that come back rejected or denied. They must deal with patients who have concerns about their bills throughout the day. They must deal with the accounts receivable process where the insurance company sends back the physician’s payment and explanation of benefits (EOBs) for posting into their software. They must verify the status of the patient’s insurance coverage. The biller must create patient invoices for any money you may owe the practice for co-pays, co-insurance, and any non-covered services. A medical billing specialist must deal with denied claims and adjustments to a claim by filing appeals to the correct insurance carrier by getting the necessary paperwork to get the claim paid and resubmitting them to the proper carrier. They must run reports for their employers, explain any of the discrepancies that are found, and have a plan in place to correct the problems in a timely manner.