MEDICAL BILLING
Medical billing is the practice of submitting and tracking claims with health insurance companies or government healthcare programs in order to receive payment for medical services delivered to patients. It is a necessary administrative activity in the healthcare business that guarantees healthcare professionals are paid for their services. The following are the most important features of medical billing:
Claim Preparation: After a patient receives medical services, the healthcare provider (such as a doctor's office, hospital, or clinic) prepares an itemized bill or claim that includes the services performed, the related charges, and the patient's personal and insurance information.
Insurance Verification: The billing team validates the patient's insurance coverage and eligibility before filing the claim. This includes verifying the patient's insurance plan, policy details, and any pre-authorization needs.
Claim Submission: The completed claim is sent to the patient's health insurance company or to a government healthcare program. Standardized codes (such as CPT and ICD codes) are included in the claim to indicate the services provided and the patient's diagnosis.
Adjudication: The insurance company examines the claim to ensure it complies with the terms and conditions of the policy. This includes ensuring that the services are medically necessary and that the categorization is correct. The insurance company may accept, refuse, or seek additional information in response to the claim.
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