Medical Billing Information and Articles
This section of MB-Guide.org is a general medical billing information resource, with articles on different aspects of the medical coding and billing industry.
You may want to start with getting the grips of the medical billing process, and the coding process. These pages explain the basics of how these fields function.
Of course, it goes without saying that you should also learn exactly what medical billing is! This page acts as an introduction to the entire area.
For a much wider perspective, see our medical billing article on how the entire medical billing industry works. It's also important to understand how health insurance companies make money (part 1) and part 2.
This article offers another perspective on the difference between medical billing and coding.
Medical coding guidelines control the whole system and make sure everything works smoothly. Becoming familiar with these will make you more effective and competent in your job.
In a similar vein, we recommend you become familiar with the most important medical billing laws. These help you to stay ethical when working in medical billing, to keep patients' privacy, and avoid getting into trouble.
Medical Billing Basics
Medical billing fraud is a big problem. It can be easy to become a victim of fraud, and anyone in the system (billers, doctors, insurance companies) can be guilty. The penalties are big fines and possible time behind bars - don't risk it!
The history of medical coding is an interesting one... can you guess which country the ICD system came from? Hint: It's not the USA!
Learn more...
Alternatively, look for medical billing and codings schools in your area.
Codes and Phrases
Our medical billing glossary explains all the important terms you need to know.
You should also become very familiar with the 3 code sets:
ICD-9 (soon to be replaced by the updated ICD-10 codes) denote the diagnosis of a patient and their treatments.
CPT codes describe what the doctors or nurses did at the office visit to treat the patient, or any tests they performed.
HCPCS stands for Healthcare Common Procedure Coding System. These codes include all the equipment and drugs that were used to treat the patient.
Because of ICD-10, HIPAA 5010 (Health Insurance Portability and Accountability Act) was implemented. This updates the standards for electronic transactions to incorporate all the necessary changes that will occur when ICD-10 is implemented.
Coders also use medical coding modifiers frequently to add extra information to a code. You'll need to learn when to use a modifier and how to use it correctly.
Knowing the different types of insurance coverage is vital. Have a look at what Medicare covers, an introduction to the basics of one of the biggest insurance programs in the country. There are actually different levels, and only the first one is free. It's also not limited to the elderly...
There's also a separate article on billing Medicare Part B, with a more in-depth focus on this one part of Medicare.
Of course, there's also Medicaid billing. This article describes the difference between Medicaid and commercial insurance plans.
A great resource is the American Medical Billing Association's website. You should become familiar with this on your path towards becoming a medical biller!
For that matter, why not have a look at the other various medical billing associations? There are different organisations that can help you depending on where you live and which specialty you bill for, but getting to knows them will help keep you up-to-date and compliant.
Medical billing clearinghouses are like big warehouses full of insurance claims. They scan each one and check for any errors which may cause the claim to be denied. Very useful for running your billing office, but there are some drawbacks as well...
See what the result of higher patient balances is, and the effect on a medical biller's job (essentially they have to work a lot more).
Timely filing is billing-jargon for making sure all claims are sent within a proper timeframe, set by the insurance companies. Being able to manage the network of timeframes is just another skill which medical billers use day-to-day! The article explains how it affects the medical biller's job.
It's important to know when a procedure is medically necessary, and how to document this.
You'll also want to learn about some common medical office procedures. These are policies and procedures which medical offices should have in place to be more efficient and compliant. They should be explicitly stated in writing.
In fact, the way a medical office and its team members function is hugely important. Learn all about how a medical office team functions together.
When insurance companies receive a claim, they put it through a process to determine if it's eligible for payment. Learn about this claims adjudication process here.
Have questions on any medical billing information? We've made a small list of common medical billing questions (for those working), and answered them! If your question isn't on the list, we've listed some other resources where you can look for more help.
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