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[C374]Certification Medical Billing And
by Ted Roxan, Ted

On February 16, 2006 the Health Insurance Portability and Accountability Act was finalized, and enacted.  This law is designed to establish national standards for all health care transactions, and to ensure the security and privacy of all health related information. The motivation behind this law is to improve the performance, and efficiency of our health care system.  This type of reform has created a need for qualified individuals who can utilize the tools of this legislation, and assure full compliance, and maximum reimbursement.  It would therefore be a prudent move for health care facilities to employ such individuals in order to avoid mistakes that could have dire consequences.

The proliferation of medical knowledge following World War II brought about an explosion of diagnostic, and treatment procedures.  As a result, there became a need to organize, and standardize all these developing technologies. Here is where the foundations of medical coding were born.   Medical coding met these challenges, and allowed for a more uniform way of communicating health information under a common language. By January 1979, standardized definitions, and codes were adopted, and used by health care providers, and insurance companies.  Since improvements and refinements of medical procedures are constantly being developed, codes must be added and updated to reflect these changes. Today, the number of medical and surgical procedures have become enormous, so too have the codes to describe them. These overwhelming numbers of codes and protocols have made outsourcing medical billing the standard.

Medical Billing and related occupations continue to be the fastest growing opportunities in health care. Insurance institutions and government agencies are investing huge resources to control claims’ fraud, abuse, and establish some degree of reimbursement parity.  As a result, more insurance companies, and health care facilities are looking to medical billing experts for help. These companies and practices are looking for experienced and educated individuals; the legal consequences of incorrect billing could be devastating.  There is a movement in the industry to make medical billers responsible for inaccuracies, much they way accountants are for tax returns.

At present, there are no standards for educational requirements for medical billers and coders. However, more employers are looking for some formal training at an accredited career training institution. These schools range in training time from nine months to two years, anything less would not be considered adequate. There is a move for certification, and several organizations are sponsoring certification examinations in medical billing and coding. Medical billers and coders earn as much as $8 to $10 per hour in the beginning, and could potentially realize $30 to $40 per hours with experience and additional responsibilities.

Today, evolutions in the health care industry are happening at a very high pace. It is only with the assistance of sophisticated computer programs, and standardized coding procedures that medical coders are now able to describe and characterize the tremendous number and various kinds of medical and surgical procedures.  These realities coupled with government regulations, and health insurance guidelines have contributed to the strong demand for experienced medical coders and billers.


Medical billing service is of prime importance for submitting medical claims to insurance companies and receiving payments. It is useful for medical healthcare providers. These providers prepare reports regarding patient’s diagnostic information and treatment, after that they submit it to insurance companies to get payments.

Today medical billing is one of the fastest growing industries. A large number of medical practitioners are coming these days. For these medical practitioners and other medical service providers, medical billing can be helpful to a great extent. They can easily get medical claims payments with no time. Now one would surely be thinking about these points:

• What is medical billing process?
• To whom these services are helpful?

Medical professionals and medical companies, whether they are small companies or big organizations, are benefited from medical billing services. This billing can be considered as a communication between Medicare providers and insurance companies.

It starts with the visit of a patient to a medical professional. Patient will tell the medical professional about his/her illness. Medical professional will create a report containing all the information about his/her illness and the treatment with which he/she can be cured the best way.

After preparing such report, he will submit it to the concerned insurance companies in order to get payments.

Now the relative insurance company will review the claim. The staff of the insurance company will study medical claims and will decide whether to approve it or not.

Approved claims are paid back/reimbursed. Disapproved claims are treated as rejected and Medicare provider will be informed about it.

When the Medicare provider receives message of rejection, he will re-interpret the claims. Then he makes necessary changes and resubmits it till the claim is approved by the insurance company. This is how medical billing is utilized by Medicare providers and insurance companies. It enables better interaction and saves precious time.
Article Source : health e tips

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Both Ted Roxan & James Weider are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Ted Roxan has sinced written about articles on various topics from LASIK Surgery, Hair Care and Health. Jay B Stockman is a contributing editor for Billing Resource. Visit. Ted Roxan's top article generates over 12100 views. to your Favourites.

James Weider has sinced written about articles on various topics from Health, Medicine and Medical Related. Author Name: James WeiderURL: Email: info@offs. James Weider's top article generates over 6600 views. to your Favourites.
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