Getting Started- The Basics (part 1)

In this blog post what I want to do and achieve, is set a really strong foundation on medical billing. This article is going to be more generic (so not focused on dermatology) as there are many things that are going to be talked about, that anyone in the healthcare industry can benefit from. So I’ll be getting into some terminology, some basic concepts and kind of sketching out a vocabulary booklet that we can always refer to, in the future.

First of all, let me just say that in order to do your billing, you obviously will need to use some kind of software. There are many great companies out there that will monitor the billing for you, in exchange for a percentage of your revenue. So you don’t necessarily need to do everything yourself. You could have an employee working on this – a billing expert, or even your receptionist (if he/she isn’t that busy…) In any case, I would never suggest you do everything on your own as a medical doctor. You have spent a solid number of years in medical school and gone through all that training for one sole purpose: to treat patients. So leave the bureaucratic boring billing things for someone else to do – unless you are a great multitasking person. Having said that, you always want to understand how the billing process works and you want to get an in-depth, inside view of what’s happening. This way you can always monitor the people working on this much better. Plus, it’s an interesting field of its own.

Getting into the basic outline of the most common software used out there (will not mention brands, as the purpose of this site isn’t to promote anyone.) With very simple software, the doctor can take care of the billing manually from an iPad or electronic device that is hooked up to his installed software. So, a patient comes in and books an appointment for a certain reason, and walks in to the medical doctor’s office. The doctor seeing the patient can easily open his electronic device (could be an iPad) and create a template of his choice via the app that is installed for the medical billing. After he has filled in the information, and that part of the process is completed, then the team in charge of the billing can start working on the other phases of that process. So for the medical doctor, as you can see, things are pretty easy. Not technical at all, not difficult to understand and very simple to use. Most available software out there, work based on this idea and basis. Remember: the whole idea for using medical billing services is to make things as easy and simple as possible. The focus should be on patient care, not simply billing him.

Below I’ve linked a very informative video I found that explains things from a software perspective. We aren’t related in anyway with the people or software being used. The explanation of everything appearing within it is just so good, that I think anyone could benefit from what’s being discussed.

This will probably make sense to you, but a physician doesn’t automatically get paid after a visit (when treating an insured patient.) All insurance based patients will have provided detailed information about their insurance before the treatment, before the visit. The only way a physician earns money from that visit, is if he actually makes claims to the insurance company to get paid for his services. From the minute a claim is being sent over to the insurance company, until the medical doctor receives his pay, there is a series of rules and regulations to be followed by both parties. So even before the submission of claims, the physician responsible for his patient, needs to make sure he abides through these specific rules before making a claim. Because of the complexity of this all, most physicians (as mentioned earlier) give out this part of their work to billing companies or even members of their staff that have been trained.

What is a billing center? It’s a center that hosts all the billing activities for the medical doctor. It’s the center’s responsibility to take care of the MD’s pay and follow the series of existing regulations. Again: it can be a part of the hospital or health center, or it can be outsourced to billing companies.

This will probably also make sense to you, but there are three main parties that are involved in the billing process: a physician, an insurer and a patient. The physician (or his billing team) needs to make sure he follows the regulations and rules of the billing system. The most well known and used claims form is the HCFA 1500 which is used mainly for professional purposes only.

Breaking down the fields in this form, there are 33 of them. Some of which include:

  • Charged details
  • CPT code
  • Standardized code
  • Format for the service rendered
  • Type of service
  • Place of service
  • Modifier added along with CPT code
  • Diagnosis code
  • Part of the body
  • Where the service was rendered
  • Units
  • Bill amount

I will be describing all this in greater detail in upcoming posts and maybe even mention a second claims form worth mentioning. In any case, stay tuned as we’ve got lots of things coming your way! If you have any questions (although we believe we’ll cover everything) e-mail us.



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