You've just come from the doctor's office, and hopefully you're feeling better. You were X-rayed, your blood was drawn and you were examined at length by the doctor. The nurse took your blood pressure, your pulse and your temperature, counted your respirations and entered this "vital signs" data into your medical record. Each of these tasks has a cost connected to it. This is where the medical biller takes over.
Significance
Medicine is an expensive business that eats up a large chunk of the Gross Domestic Product. Costs are associated with each service you consume by the many health care providers you encounter. Because medical costs are not particularly transparent to the consumer, it is essential to have experts who can navigate the complex process of medical insurance billing.
Function
Medical insurance billing is the act of taking the Current Procedural Terminology or CPT codes created by the American Medical Association. These codes represent services you consumed from your health care provider or hospital. The medical biller matches the coded services to a price list created by the hospital or doctor. Then, the biller creates a claim or invoice that is submitted to your insurance company for payment. Billers can do this manually, but many use software products that help them create an accurately coded bill.
Types
Because medical insurance billing is complicated, there are different tasks that must be performed based on the types of health care services billed for and the location where the services were provided. There are also different sets of billing codes that need to be entered on a claim that is submitted to your insurance company for payment. The medical insurance biller creates both the bill and the claim.
Inpatient
If you were a hospitalized patient, the medical biller responsible for creating the claim for payment that was sent to your insurance company is called an inpatient biller. He or she reviews the CPT and International Classification of Diseases codes, or ICD codes, assigned by the hospital coders to identify the services you received. The hospital biller will match the ICD codes to the hospital's list of prices and create a claim or bill that is sent to your insurance company. The hospital biller may also be responsible for helping calculate the amount of co-pay you owe for your stay. This amount will be based on the benefits you have purchased from your insurance company.
Outpatient
Medical billers working in the outpatient setting create bills that correspond to the codes that match the services your received as a patient. Outpatient billers work in every care setting except the inpatient hospital. This can include clinics, doctor's offices, physical therapy centers, dialysis units, chiropractic and dental offices, birthing centers and emergency departments. The PT codes they use to create the bills are different from the inpatient biller, but their tasks to create the bill are much the same.
Considerations
Medical insurance billers need to be trained and have basic skills and interests that include precision, focus on detail, customer service skills, the ability to learn computer programs and an interest in health care in general. They need to be comfortable working with numbers and constantly changing billing code data. These skill sets apply to both in and outpatient medical insurance billers.
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