Medical billing is a process that involves insurance company or the patient as a third party payer and results in claims for medical services like treatments, procedures and testing that are being rendered to the patients. This process can take several days to several months to get completed and also involves several interactions between the parties for settlement. Thus, it can be easily said that medical billing is a payment process within a particular country that involves a health care provider submitting, following up on and appealing claims with health insurance companies in order to collect payment for services provided.


In medical billing, the claiming process starts when a patient is treated by any health care provider and the provider sends a bill of services provided to a designated payer which is a health insurance company in common. The payer company then evaluates the claim by going through a number of factors and determining protocols, if find the claim appropriate, involves in reimbursing the claimed amount to the provider. When a patient receives services from a licensed provider, the services are recorded and assigned with a specific code by the medical coders and the summary of services communicated through these codes helps in preparing the bills and after any added information the claim gets ready for processing.


To settle the insurance claims accurately between the providers and the payers, a number of technical and industrial standards and protocols have to be maintained. Software is generally used having some pre-set guidelines and methods to calculate and evaluate the reimbursement amount after successfully evaluating the data provided by the health care providers. Either manually on papers or electronically the delivery to the payers can be done although the majority, nowadays, prefer the electronic process for being faster, accurate and even cheaper compared to the other one. This electronic process for transmitting claims for medical billing service involves optical character recognition methods for isolating and recording information in related fields and transferring them into other sectional documents when required but human oversight is definitely needed for ensuring accuracy.


After the patients’ visit with the medical staffs for diagnose and procedure codes are created and recorded and when all required data have been entered and checked the provider creates a claim for the appropriate payer. A claim payer should receive only what is needed to process a claim and thus information about other dates of service or conditions not included in that claim should be deleted before mailing to the payer. The patients’ appropriate insurance coverage for the visit is also observed carefully. The requested claims will then be judged and investigated by the payer for approval or denial or even for pending where extra supportive documentation is needed.


Thus, it is clear that in medical billing transmitting claims has always been a serious and tough work to perform as the exact monitoring of services that are provided and the minute observation of the policy details both are very important factors for making successful claims.

Ravish Kumar

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