Billing and coding procedure in the medical field

Just like in any other public facility that offers particular services to individuals, the services you access from medical facilities involve billing and coding procedures. These are critical processes, and they include several staff members working in such facilities. Some of the responsibilities of those who engage in billing and coding tasks in such facilities include;

  • Evaluation and analysis of insurance covers, medical charges, and preparation of accurate billing forms.
  • Collection of payment from various insurance plans or individual patients.

The medical billing and coding training in New York procedure is as explained below.


Patient check-in

It is the first process when a patient books an appointment to see a physician at a medical facility. Hence, when the patient comes in, details about their name, address, birth date and the reason for their visit will be collected by the front office staff. In addition to that, they will also obtain details about the name of the insurance provider and the policy number as well.

Confirmation of financial responsibility

The next process is to confirm who will be responsible for paying for services rendered at the medical facility after the necessary details have been sourced from the client. That is because some insurance companies dictate what medical conditions are covered and those that are not.

Patient check-out

After treatment, the physician should ensure that they record all the medical services rendered to the patient, which will feature in the patient’s medical record. Medical coders feed these details into a system through medical code sets that are used in the healthcare industry.

Coding and billing compliance

Once a medical bill is generated, it should be sent to the payer, but before sending, it should satisfy particular conditions. These conditions relate to the medical services rendered, the coding and billing procedures as well as the insurance provider. Medical billing and coding training in New York gives insight into all the necessary conditions that should be met.

Transmitting claims

At this stage, the bill is ready to be sent to the insurance provider and to ensure that the patient does not remain in the hospital because of pending bills, it is important to expedite the process. That makes transmission of claims a critical part of the medical billing process. Submission of billing details of a client should be through the electronic platform because it is both fast and saves on cost as well.

Receiving payment from insurers

Insurance companies will perform a process called adjudication once they receive the medical bill through a series of steps to evaluate the claim. It is at this stage that insurers decide whether they will pay the bill in full, partly or reject the bill as a whole after considering some factors.

Billing patients

If an insurance company pays only part of the bill, the biller at the medical facility should provide details of what was spent and the difference that remains unsettled for the patient to pay. All those undergoing medical billing and coding training in New York need to understand this procedure to function effectively.