This essential aspect of healthcare is the focus of a unique profession
We all go to the doctor, whether it’s for a routine checkup or a specific treatment or procedure. Some time afterwards, you may get a bill for the portion of your treatment that your insurance did not cover. Did you ever wonder what happens in the time between leaving the office and getting that bill?
Given the realities of today’s healthcare and health insurance industries, there is a specific path that these claims tend to follow. And there is one professional who’s responsible for shepherding these claims and making sure that the appropriate paperwork is filled out correctly: a medical billing and coding specialist. The Salter School offers a training program to equip students in this specialized career.
Here are some of the steps a medical billing and coding specialist would take to process the average claim:
- Gather patient information
- Do insurance verification
- Check with the patient about coverage
- Record patient services
- Collect patient co-pays
- Assign a code (or codes)
- Generate a claim
- Receive (and post) payment for services rendered
In some cases, the insurance company may send the patient an Explanation of Benefits (EOB) that explains how the claim was processed and specifies how much the patient owes. (Patients may be able to log into their insurance carrier’s website in order to read these EOBs online.)
Once the insurance company receives the claim, it will take a close look at the codes the medical billing and coding specialist has submitted, in order to match them up with the patient’s benefits. Only then can the insurance company determine how much of the bill it will agree to pay. Should the insurance company refuse payment for some aspect of treatment, the medical biller would then need to send an invoice to the patient directly.
Given the number of steps involved, it’s easy to appreciate why people who do this job need to be so analytical, conscientious, organized, and detail-oriented. At many stages of the process, the attentiveness of the medical billing and coding specialist can make the difference between things going smoothly and problems or delays in the office receiving payment.
At the Salter School, we prepare people for this detail-oriented line of work. If you’re considering a career change, and this aspect of healthcare appeals to you, contact us to find out about the training for this specialty. It might inspire you to change careers—perhaps even this year!
This article is part of the Salter School’s weekly blog. We are dedicated to supporting our students in creating satisfying lives, both personally and professionally. Learn more about the programs we offer at our two campuses in Massachusetts.