Medical Billing Process in United States

Medical Billing Process in United States

Medical billing is the process of medical payment which is practiced by the health service provider in the United States. This process is also known as Medical Billing service. The medical billing service involves a medical service provider submitting a claim, following it up, and receiving the feedback from health insurance companies to obtain the equivalent payment for the services rendered. Services rendered including emergency treatment, diseases treatment, medical check-ups, etc.

When a patient visit a medical service provider, the medical records of such patient is recorded, the diagnosis, prescribed medication, the space fee, treatment asserted by the medical service, and all relevant medical information are registered. These are carefully recorded either manually through medical files or electronically for future purposes and updates. This process is also used by insurance companies and medical services sponsored by the government.

The beneficial of the medical service is the patient and the first party while the medical service provider is the second party involved in the medical billing service. The medical service provider includes the doctors, physicians, physical therapist, nurse, emergency room, midwifery, outpatient facility and any other areas where medical care are rendered. The third party involved in medical billing service is the insurance company. Although the visitation of the patients is usually thought to be the only one involved in the medical billing process, the fact is that there are about three different types of people involved. The patient with an insurance policy only needs to visit the provider of the medical service, the medical service provider under the desk of the biller ensures that the healthcare provider pays for the services rendered by the patient and the payer (which might be the insurance company). This makes the set up a kind of three-way system.

Apparently, the Medical Billers and Medical coders play a marvelous role in establishing a communication between the medical service providers, the patient and the insurance company involved. A medical biller and coder collect the information of a patient (which can be found in a “superbill”) and read the chat of the patient to determine his medical history. The medical history such as the diagnosis, the treatment, the prices of the services received by the patient and other services offered to the patient is then compiled into a bill for the insurance company. This kind of bill is known as a “claim.” The claim contains the information of a patient, medical history, and a report of the services rendered by the medical service providers and why they gave such services. Based on the medical records, a set of medical codes are used to transcribe the patient’s history in (a short-hand-like) font which can then be decoded by both the medical service providers and the insurance company.

Other services carried out by the coders includes the reading and analysis of a patient records, determining the codes of a patient record, and using the code to bill the insurance company, interacting with the physicians to ensure accurate codes, keep an up-to-date data of a patient visit, managing the information of the patient, securing the information of patients among others.

It should be noteworthy that Medical claim adjusters or examiners or sometimes medical doctors process claims, examines it and evaluate the validity of the application. If the claim is right and genuine, the medical service providers will be paid based on their negotiations with any rejected claim sent back by the insurance company. If a claim is denied, it must be reviewed, reconciled, corrected and re-filed. Sometimes the complexity of the medical billing and coding system causes the rejection of claims, the services not covered under the insurance policy are also rejected sometimes among others.


About J2 Global Healthcare Medical Billing Company

J2 Global Healthcare is a full service medical billing company providing services to physicians, practices and hospitals. We have been providing billing services for hospitals for more than 12 years with good quality, and better price. For more information contact J2GHC Medical Billing Services by email at, by phone at (706) 538-3337 or visit the J2GHC Medical Billing Company website.


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