Medical billing in Illinois is a big business that allows medical professionals to ensure their billing methods are done correctly. Medical billing is something that is not usually done in the office of a doctor and can be sent out to independent contractors. It involves properly coding the bills and submitting them to the respective insurance companies. The purpose of this is, of course, for payment of the services rendered by a physician to an insured individual.
Medical billers can be certified but are not legally or medically required to do it. The training teaches an individual the process of completing the medical billing and coding and how to follow through with the various insurance companies with which you will be working.
The Billing and Coding Process
Medical billing in Illinois does involve a short to an extensive process. First, the individual doing the medical billing has to have the code schedule from the doctor to do the billing to the insurance company. The coding part involves the reducing of the procedure and the diagnosis to a numerical code. When the individual doing the coding and billing has all the procedures and diagnoses codes in place, he can send the claim to the insurance company, usually in an electronic format. There are some medical claims that are still sent to the insurance companies via paper forms.
Medical Billing and Regulations
Most have heard of HIPAA and all that is involved in protecting the privacy of the patient. This requires most billing and coding transactions be sent electronically because it has been determined to be a more protected format. Medical billing in Illinois includes several transactions. All of them have to abide by the same regulations to protect the patient’s privacy.
There may be a communication between the health provider and the insurance company to question if they cover a certain treatment. That form is an X12-270. The first transaction for a request to cover a claim is known as the X12-837. All these aspects are what a student can expect to learn when taking a course in medical billing in Illinois.
Finally, when the claim is accepted and paid, the form that is electronically transmitted is X12-835. The medical biller has to known various insurance plans and the laws and regulations that cover them. In a course in medical billing in Illinois, the student will learning medical terminology and how the code each experience, treatment and diagnosis for the patient.
