Before we dive into the world of medical billing, let us discuss what it is exactly and how it differs from medical coding.

When a patient visits a healthcare provider, notes are documented with items such as the patient’s conditions, diagnoses, and procedures taken. These procedures all have a unique code attached to them which will then be used in the process of collecting payments for these services.

Medical coding is the process of transforming the information from patient records into specific codes that match the diagnoses identified and procedures performed during the visit.

Medical billing, on the other hand, needs information that comes from medical coding.

Billers take every procedure code that coders put on a superbill and create a claim for that patient’s visit. The claim is then sent to request payment from the insurance company or Medicare and Medicaid.

The goal of a medical biller is to ensure payments are made correctly.

After claims are submitted, the insurance payor will make a decision on the payment and send back an explanation of benefits (EOB). This shows how much was paid and why it was paid.

After the EOB is received, the medical biller has other responsibilities that may include:

  • Reviewing the EOB
  • Understanding the reason behind payments
  • Calling insurance companies to inquire about payment information
  • Identifying claim errors
  • Making timely follow ups and appeals on payment discrepancies
  • Ensuring everything is HIPAA compliant

At the end of the day, the role of the medical biller is crucial to receiving payment for patient visits. From submitting the claim to following up, a medical biller is involved every step of the way.

Americare Network delivers a customized medical billing solution for each client. From data entry to making appeals, we cover a comprehensive set of billing and collection services. Contact us today to hear about how we can help you. We also help with medical financing, chronic care management, and other services so you can focus on what you do best…care for your patients.

Read about The Americare Promise™ here.