MEDICAL BILLING

BY
ELIZABETH TOJO
 DEFINITION

MEDICAL BILLING IS A PROCESS OF SUBMISSION

OF BILLS TO THE INSURANCE COMPANY IN A
SPECIFIED FORMAT FOR THE SERVICE RENDERED
BY THE PHYSICIAN ON THE PATIENT.
 3 MAIN PARTIES
PATIENT

PROVIDER

BILLING OFFICE

CLEARING HOUSE

INSURANCE COMPANY
BILLING OFFICE
 RESPONSIBILITIES OF A BO
CODING

MAINTAINING PATIENT REOCRDS AND ACCOUNTS

FILING CLAIMS TO THE INSURANCE COMPANY

FOLLOWING UP WITH THE INS CO & THE PATIENTS

ASSURING HIGH PRODUCTIVITY & REIMBURSEMENT

STRICT ADHERENCE TO THE RULES & REGULATIONS

OF THE INSURANCE COMPANIES
 DEPARTMENTS IN A BO
PRINTING
CODING
PRE-VERIFICATION
CHARGE ENTRY
AUDIT / QUALITY CONTROL
CLAIMS & TRANSMISSIONS

CASH POSTING
ACOUNTS RECEIVABLES
COMPLIANCES
 INSURANCE COMPANIES

THERE ARE TWO KINDS OF INSURANCE COMPANIES.

THEY ARE :

 FEDERAL INSURANCE COMPANIES

 COMMERCIAL INSURANCE COMPANIES

 FEDERAL INSURANCE
COMPANIES
•GOVERNMENT INSURANCE COMPANIES

•MOTIVE IS WELFARE

•EXAMPLES :

 MEDICARE
 MEDICAID
 CHAMPUS
 CHAMPVA
 COMMERCIAL INSURANCE
COMPANIES
•PRIVATE INSURANCE COMPANIES

•MOTIVE IS PROFIT

•EXAMPLES:

 AETNA
 CIGNA
 BCBS
THANK YOU