Medical Billing Practice

Critical Information Relating To the Medical Billing Practice

Medical billing is defined as the payment practice that is prevalent in the United States health system and is thus protected by law. The process has several identifiable processes which have been codified into practice. These processes include the healthcare submitting and following up on claims with insurers in a bid to receive payments for services rendered to patients. On the end of the spectrum is the process that is in use by most insurers to manage payment claims by healthcare service providers.

The medical billing process is dependent upon medical coding as the primary record keeping process. Medical coding or medical classification is the process of transforming prescriptions of medical diagnosis and procedures into a universally recognized and accepted set of medical code numbers. These are taken from a variety of sources within the Electronic Healthcare Record, HER, which include transcription of the physician’s notes, lab results, radiologic results and various other patient information records sources.

Automates the Task of Making Claims

A medical billing company, therefore, is the company which is responsible for the collecting, collating and onward transmission of these records to the required parties. The records that they possess are primarily useful in making claims for reimbursement on behalf of the healthcare service provider from the payer (e.g. insurance companies) and they earn a commission of the payment as their pay. Additionally, these records are useful for the statistical analysis of diseases and the accompanying therapeutic actions which are important for the direct monitoring of epidemics or pandemics.

Medical billing is a process which is a close interaction between a healthcare service provider and an insurance company and this relationship is governed by certain rules and regulations. And as with anything else in the field of information technology, these processes are all designed for one major purpose, namely, to automate a task and make life that much easier for all participants. Thus, a medical billing service provider should be able to offer you as a healthcare service provider some efficiency in the process of managing claims and payments.

Critical Checklist

To this end, they must display the following characteristics, which should be a signal at their suitability for the job at hand. The following checklist is important for you as you evaluate the services of a potential firm:

  • Is their software adaptive in making full use of the HER specs as defined by law?
  • Can they convert the bills to claims? Does the system undertake electronic submission and verify the same?
  • Does it offer comprehensive and easy-to-comprehend accounting and billing reports?

If the answer to all of the above is yes, then you are good to go.

Additionally, you should be interested in finding out if the system undertakes electronic tracking of payments in a clear and transparent manner and if it has a claims rejection analysis which is undertaken in real time and one which displays the error codes clearly and concisely. It should integrate co-payments into the scheduling features, pull the codes directly from the EHR system and be secure, user-friendly and with enhanced features for data recovery.


Jones Karpov is a Bio-Informatics professional who runs a medical billing company that has won several awards throughout the years due to the innovative solutions. To learn more about medical billing, visit this website.