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Introduction to Medical Billing

This guide is a brief introduction to the forms and processes that are used in Medical Billing. Medical Billing is an industry that that continues to grow, despite the ups and downs of the economy. Hospitals and other health care businesses depend upon capable Medical Billers and Coders to help them collect payments from Medicare, Medicaid, the VA, TriCare and private insurance companies.

Without Medical Billing, hospitals, nursing homes, doctor’s offices and other health care businesses would not be able to care for their patients. This makes a Medical Biller an important part of the health care team. Medical Billing is an important and rewarding career choice that can be pursued by all ages and physical ability levels. Medical Billers may work in a hospital billing department, a multi-physician practice, a nursing home, a private nursing care company, a small physician’s practice or work as a freelance consultant and biller.

Medical Billers should be computer proficient with self-discipline and attention to detail. Knowledge of anatomy, medical terminology and procedures is necessary. Billers should be able to interpret medical procedure lists into comprehensive bills using CPT, ICD-10, and HCPCS coding. Learning these important skills is not difficult, making this one career that can be started relatively quickly and easily.

A skilled Medical Biller has plenty of opportunities for career growth. Those working in hospitals may be in line for advancement, and freelance billers who display excellent skills and stats can earn additional and more prestigious work.

The information in this guide should help you learn more about this exciting, and rewarding career. You will learn about the main forms, how to fill them out, some of the most common errors you will want to avoid, and how to learn more about Medical Billing and Coding. Because forms and procedures can change with revisions to health care laws, it is important to make certain that all information is still current and correct.

Using this guide you should be able to get a clear picture of Medical Billing and Coding if you are new to the industry, and for Medical Assistants and other Health Care Administrators, this may be an excellent tool for cross-training and to use as a refresher course.

What is the CMS 1500 Medical Form?

The CMS 1500 is the standardized form used by individual health care providers for billing purposes. The form differs in scope and purpose from the UB-04 because it is used for individual providers, not hospitals like its counterpart. There may be several different CMS 1500s generated from a single hospital visit as each provider bills for services provided.

The CMS 1500 has thirty-three fields that must be completed completely and thoroughly to avoid rejection of the entire claim. The form is used on a daily basis by anyone who works in an administrative position anywhere in the medical office. Each field on the form plays an important role in the billing process and the Medical Biller must become familiar with each of them.

Unlike the UB-04, the CMS 1500 uses CPT codes instead of HCPCS codes for its procedures. Because an individual provider does not perform the same quantity of procedures as would be performed in a hospital, not as much space is needed for procedure and diagnosis codes. The CMS 1500 is simpler than the UB-04, because it does not have the same comprehensive functions, but the same level of accuracy is still required.

What is the UB-04 Medical Form?

The UB-04 is also known as the CMS 1450, and is the main form used in billing and insurance, throughout the United States. The form is a comprehensive document that collects all information needed during the Medical Billing practices. The form was created by the National Uniform Billing Committee, and became the main form submitted by health care facilities in 2007. The UB-04 has spaces for all of the information needed to process a medical claim.

Health care professionals use the UB-04 to submit claims for inpatient medical procedures and services. The UB-04 is used by hospitals, hospice care, skilled nursing facilities and other medical institutions for claims to Medicare, Medicaid, TRICARE, and other state and federal agencies that offer health care coverage, as well as private insurers and HMOs. The Healthcare Common Procedure Coding System, or HCPCS, codes are used to ensure that the correct procedure, service, or equipment are being used and billed for.

The UB-04 is a much more complex and detailed form than the CMS1500, because it involves all services rendered within the hospital’s scope of care, including supplies, medications, nursing care and medical equipment. The billing department fills out the UB-04 thoroughly and accurately, and then submits the form to the patient’s insurer. The form is reviewed by the insurance company and compared with the patient’s coverage. Covered benefits are paid at rates that have been negotiated in contracts and renewals between the hospital and insurance company.

The job of the Medical Biller is to ensure that the UB-04 is filled completely and that all information is correct. If the information is incomplete or incorrect, the form may be rejected by the insurer. This is why it is important that everything is done properly, so that the form is accepted and paid the first time it is submitted.

What are the Benefits of Using Medical Billing Software?

Medical Billing software has transformed the Medical Billing industry. Forms are much easier to complete, as the fields are generally populated using database information. Software can also catch most discrepancies, such as HCPCS and ICD-9 codes that are not compatible.

Commonly used codes, patient information, and provider information are able to be stored, and forms can easily be duplicated as needed. Electronic forms can be submitted through secure channels to the appropriate insurance company. This speeds the billing process significantly and adds a level of security that is not present in paper billing forms.

There is a wide variety of Medical Billing Software types available on the market. Each has a specific purpose or advantage that may not be found in other software. Some of these software suites can be used for managing the entire practice, which streamlines the billing process even further. Some may be web-based, others are created expressly for the hospital and information remains in the hospital’s intranet servers, except when submitting for payment. The hospital’s IT department will consult with the various departments involved before deciding upon a specific software system.

While Medical Billing Software is not a substitute for a skilled Medical Biller, it has made great strides in improving the speed, efficiency, and accuracy of the overall billing process. Medical Billers using software should learn the software thoroughly and check all of their work to ensure accuracy. Medical Billers can use the Medical Billing Software as a tool to ensure that their billings are complete and correct, making certain that they are accepted and paid the first time.