How does Medical Billing work?
The billing process is started by an office visit from a patient. When a patient is seen by a physician all his medical information is collected. The doctor’s assessment of the patient, the complexity of the medical decision making and the patients history are all used to determine a correct level of service that will be used to bill the insurance company. The level of service is translated into a five digit CPT code from the Current Procedural Terminology. The verbal diagnosis is translated into a numerical ICD-9-CM code. Both of these codes are used for claim processing. Once these two codes have been established and all the patient information has been filled out, the medical biller generate a file, that is in the ANSI 837 file format, and transmit the claims to the insurance company electronically using EDI, or Electronic Data Interchange, to submit the file to one of many clearinghouses or directly to the insurance company. The insurance company or clearinghouse will respond with
