Saturday, April 6, 2024

What is Medical Billing? Introduction to Medical Billing 2022

Must read

Medical billing is one of the essential parts of the healthcare industry. Many may wish to work as healthcare professionals. We can introduce medical billing as one of the best level positions that they can choose through proper channels. However, many people may still be without much knowledge about medical bills. What are medical bills? What does a professional medical billing specialist do? We’ll give you a clear explanation of many such questions. 

What are medical bills?

Medical billing is preparing claims to submit to insurance companies to obtain payment for medical services provided by a particular provider. After any health care becomes a billing claim, the biller claims to ensure that the provider is reimbursed for the work performed. A medical biller with a higher level of education, knowledge, and experience can optimize revenue performance for a medical practice.

Refer More: Introduction to Medical Billing 2022 

Why bill medical services?

Going to the doctor for any condition may seem like a simple interaction between you and the doctor, but it is a very complex process inside. After seeing the doctor, billers make all payments through a sophisticated information system. 

It is a complete process by a combination of 3 parties. The first part here is the patient. The second part is the healthcare provider. The health care provider we refer to here is anyone, such as doctors, physical therapists, outpatient facilities, emergency rooms, etc. Also, the last party here is the insurance company or the paying party.

Read More on: Reasons To Start A Medical Billing And Coding Career

Duties of Medical Biller

The functions of the medical biller are organized among the three parties mentioned above. By billing through both the patient and payer divisions, the biller confirms that they are compensating the healthcare provider for the service. 

The primary purpose of billing is to ensure that health care providers are paid for their services. For this entire process, the biller collects relevant information about the patient and the patient’s procedures and prepares a bill for the insurance company. It is a claim. The report includes patient demographics, insurance coverage, medical history, system reasons, and more.

 The biller should review the patient’s medical charts and insurance plans to verify service coverage. Then they check their accuracy. Next, generate medical claims. Finally, they present them to the billers. After the payer approves the claim, they return it to the billers with the amount they agreed to claim.

Then the medical billers must prepare the patient’s bill before the patient visits the doctor. In this process, billers deduct the amount covered by insurance from the service cost, collect outstanding patient balances, send invoices, and mail payments. Then they can relieve it only if the patient wants it. However, there’re many other tasks involved in medical billing.

Medical billing process

Medical billing is not a simple two or three-day process. It may take a period, from a few days to a few months. 

The complete cycle involves several steps. However, the No. 1 task here is correct issuing medical bills and timely follow-up. It takes 35 – 45 days to complete a billing cycle, which can vary from state to state and service location.

Thus, some errors that may occur during the billing cycle, administrative tasks, revenue, and other services may increase the value. Accordingly, they determine their value based on the functions of the billers in the entire billing process. In health care systems and organizations, financial health depends on the strength of the front- and back-end billing staff.

To learn more about Medical Billing Process, refer to the Medical Billing Process Guide article here.

What is Front-End vs. Back-End Medical Billing?

As mentioned above, we can divide the medical billing process into stages. That is, they are mainly the front and rear ends. Pre-final billing refers to the service performed before the patient meets the doctor. This phase involves the frontline staff.

The provider ends the patient visit next. After that, back-end billing takes place. Here they must complete the tasks of the medical coder first

After that, the billing process starts again in the back office. The billing staff involved in the latter functions focus on claims management and full claim reimbursement.

Back-end billers have to implement a fairly complex system. Front-end billing activities primarily impact revenue cycle management. All stages of the billing process require certified professional billers.

Insurance claim

Insurance claim processing begins when the patient contacts the provider’s office to schedule an appointment. Otherwise, processing of an insurance claim will also begin upon registration at the hospital. Here the staff will collect the patient’s insurance information and other details. Or after they arrive at the workplace, complete a patient registration form.

The billing staff organizes activities to avoid data capture errors during these tasks. To obtain payment, front office staff can verify that the patient’s health plan covers the services.

There are several forms of health insurance. Meanwhile, insurance is the payment made for the services that the patient can choose from any provider. This form of insurance is quite expensive. Also, indemnity insurance becomes less popular when healthcare prices rise slightly. Each type of insurance has different procedures and services that they cover. The medical biller’s responsibility here is to interpret a patient’s insurance plan and use relevant information to prepare an accurate claim.

Creation of rights

The main task in medical billing is to create claims. That’s where medical billing and coding directly overlap. Billers make claims using codes for procedures and diagnoses processed by medical providers. The procedure codes mentioned here provide details about a patient’s visit, and the diagnosis codes indicate the reason for the same.

The biller adds details of the patient’s visit and procedure to his claim. Therefore, the relevant claim contains a complete patient data description. In such a case, it is up to the biller to verify the correctness of the claim. It is a rather complicated process that is left to the biller. For this, the biller must understand how much they will reimburse the provider for the procedure.

Daily Activities of the Professional Medical Biller


A medical biller constantly communicates with insurance payers, providers, and clearinghouses. The biller should always have a good explanation and follow-up with all parties in the health care process. In addition, billers may also be required to provide a better description of their bills to patients. They should also follow up with the patients regarding the payment of the balance of the medical bills.

They also provide a list of procedures covered by the payer.

Computer experience

You know that nowadays employees are using computers to make work efficient in any office worldwide. Accordingly, billers also have to use some form of practice management software. The software tracks patient information. They can perform many tasks like scheduling visits, storing medical data, and scheduling appointments.

Communicate with patients

When patients receive medical services through any healthcare provider, they are issued a bill at the end of the service. The complex process is left to the biller, who creates it by checking the patient’s balance.

Then, add the cost of the procedure or service minus any mitigating factors. The biller has to work with the patient’s medical records. Coders use medical records to translate medical services into the correct codes. Billers then process insurance plans to create accurate bills from patients’ medical records.

Claims Process

Medical billers must complete the claims process mentioned above as part of the billing cycle as a daily task. Most of their day is spent completing these tasks. Here, billers should familiarize themselves with what type of claim the insurance payer will accept. For that, they should frequently work with insurance clearinghouses. Any claim sent by a victim must be very accurate. They must ensure that the health care provider receives reimbursement quickly and efficiently, and the biller must process prompt payments. 


More articles

I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder. I am certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and by the Practice Management Institute (PMI) as a Certified Medical Office Manager (CMOM). As an office manager/biller/coder, I was a member of the Michigan Medical Group Managers, Michigan Medical Billers Association. I also served as a committee member of the Michigan Osteopathic Association of Practice Managers Education Committee.

Latest article