Understanding Your Medical Billing Terminology

Without effective medical billing services, our medical systems would not be able to count on receiving payment as regularly. That makes medical billing services an essential part of our medical infrastructure. Maybe that is why the medical billing service industry in the United States alone generates more than $5 billion in revenue every single year!

One of the most famous things about medical billing is how complicated it is. Even people who work with it in a professional capacity often fail to learn the finer points of medical billing terminology.

Some people develop a habit of looking up terms they don’t understand every time they come across one. However, it is often more efficient to take a little bit of time, especially for familiarizing yourself with the medical billing terminology you know less about.

So what are the most important things to understand about medical billing terminology? Read on to learn all about some of the most essential medical terms to be familiar with!

Statement Follow-Up

Many people are familiar with the earliest steps in the medical billing process. However, the later steps are somewhat more of a mystery to them. So what does it mean when you see a statement follow-up in medical billing terminology?

The statement follow-up is the final step in the whole medical billing process. It makes sure that all bills are paid the way they were intended to be.

In some cases, the statement follow-up will reveal that certain bills have not been addressed. When that happens, it can mean that you either need to follow up or send an account to a collection agency.

Patient Statement Preparation

Before the statement follow-up, there is the patient statement preparation. At this point, the patient receives an official bill for all of their charges.

The patient statement preparation should be itemized. It will list all treatments a patient received.

This document will include medical pricing for each provided service. This itemization allows patients to examine their charges. Then, they can make sure that they are only being charged for services they really received.

Medical billing terms and medical lingo are complicated. People and institutions sometimes make mistakes. The patient statement preparation step in the medical billing process helps protect against costly errors.

By providing the patient with the information they need to correct medical bills, we can decrease total effective errors. The patient statement preparation will also include how much of the relevant charges have already been taken care of by insurance.

Monitor Claim Adjudication

The monitor claim adjudication step shows a similar kind of statement to insurers. This allows them to correct any mistakes they see on the bill.

That means that there is a double layer of protection from unnecessary medical mistakes. When an insurance company accepts a bill, they will then pay it unless something unusual happens.

However, they may also choose to deny a claim. In that case, they will refuse to pay the bill.

The entire amount will then be passed on to the patient during the patient statement preparation. At that point, as we have discussed, the patient can correct any problems they perceive.

Insurance companies can also reject claims without denying them. That means that the claim needs to be corrected before they are willing to pay it.

Once those corrections are done, the bill goes back into the monitor claim adjudication step. This process can repeat as many times as possible until the insurer agrees that the bill is correct.

Claims Submission

The claim submission step is when the healthcare provider sends their completed form off to be reviewed by someone else. In many cases, such bills will go first to some kind of third party.

These third parties often act as liaisons who help both providers of health care and health insurers. It is important not to submit such a claim until it has been thoroughly checked for accuracy.

Claims Generation

Before such a claim can be checked for accuracy, it has to be created in the first place. Medical billers create these claims during the claims generation process. They also check the final result for compliance with various regulations and compliance standards.

Superbill Creation

The superbill is a valuable document that contains all of the most essential information for a certain step in the medical billing process.

The superbill contains standard information from the relevant patient. That includes their contact information and insurance information.

On top of that, the superbill will include information about the medical provider and the clinician who provided medical treatment. The superbill will also include more detailed medical information about the history of the patient and what kind of treatment they received.

Financial Responsibility

Before you can create a superbill, it is important to know who is financially responsible for medical bills. That means first examining the information received from the patient during their visit.

In most cases, the most important detail to look at is whether or not the patient has valid medical insurance. At this point in the primary specialty physician medical billing process, it is important to let the patient know if there are any costs that they will be personally responsible for.

Patient Registration

The whole process starts with asking patients to fill out standard information on medical paperwork. That is why it is important to collect this information from a patient as early as possible during their medical visit.

In some extreme cases, a patient may need medical attention right away. In that case, you may not proceed to the patient registration step until a patient has already received medical treatment.

Once they are stable, you can ask them to fill out the right forms. You may also be able to have a family member or spouse fill out these forms for the patient.

Understand the Most Important Things to Know About Medical Billing Terminology

Most people do not think of medical billing terminology as the most fascinating subject. However, taking the time to zoom out and show up your weak points in understanding can have disproportionate benefits. The time that you spend learning to better understand medical billing terminology can help you navigate the world of medical billing faster forever after.

To learn more about the latest information in medicine, finance, and more, take a look through our other articles!

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