This course addresses coding procedures and insurance billing procedures. Students also learn through computerized billing simulations how to create, save, retrieve, edit, and maintain patient files. In addition, post payments to patient accounts, produce insurance claim forms, correct, and resubmit rejected claims, produce insurance claim activity reports, and enter electronic claims.

The medical billing process can be frustrating. Converting your patient notes to numbered claims can introduce human error, and insurers can be strict about how claims are formatted for approval. Even if your claims are approved, insurers rarely pay immediately. The best you can do amid these challenges is to establish consistent workflows for your claims and reimbursement processes.

The physician does not get paid for his services immediately after they are rendered. A majority of patients have insurance coverage, and the details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting claims and getting paid is not as simple as it looks. It is a lengthy process and involves a lot of rules and regulations, systems and is very complicated. The physician cannot provide his entire attention to this activity. Hence the concept of Medical Billing was established.

There are three parties in the Medical Billing Process. The PHYSICIAN, the INSURANCE COMPANY, and the PATIENT. The Physician is required to comply with the rules and regulations as described by various insurance companies in submitting claims and at the same time, ensure positive patient experiences in meeting financial responsibilities.

Physicians appoint Medical Billing Companies to take care of their patient billing. The Medical Billing Companies and Physician enter into an agreement that outlines their duties and responsibilities in patient coverage. The main objective of the Billing Company is to maximize the collections for patient services provided.

In simple terms, the main function of a Medical Billing company is to help healthcare providers and organizations process patient/client information in order to get paid on time. The term “healthcare providers" refers to Physicians, Psychotherapists, Psychiatrists, Chiropractors, Nursing Practitioners, Dentist, Medical Social Workers, Physical Therapists, Occupational or Speech Therapists. It also includes healthcare businesses such as: Ambulatory Services, Durable Medical Equipment Suppliers, Medical and Surgical Suppliers, Medical Laboratories, Clinics, and organizations that include Nursing Homes, Home Health Care Agencies, Rehabilitation Centers, Hospice Care Centers, and Hospitals.
Claim filing to private insurance companies and government sponsored programs such as Medicare and Medicaid consist of the main business of a Medical Billing Service Company. However, we cannot ignore the importance of good record keeping. A Medical Billing Company’s job is to make sure clients maintaincompliance with current government rules and regulations.

Grading:

Student performance will be evaluated relative to knowledge, skills, and professional behavior.  Exams, quizzes, and projects will provide evidence of success in meeting the course objectives.

 Scale:

Note: A grade of 75% is required for successful completion of the course.