Medical billing and coding are two sides of a coin which the modern healthcare system is tightly linked. Both practices are part of the vital reimbursement cycle, which ensures that health care providers are compensated for the services they provide.

Medical billing is as straightforward as it sounds: medical billers take information from medical coders and create a bill for the insurance company. This bill is known as a claim. In addition, the biller receives evaluated or ‘adjudicated’ claims, analyses them, and subsequently generates invoices for patients and this process isn’t as simple as it appears. The medical biller takes the codes that indicate what type of visit it is, what symptoms the patient exhibits, what the doctor’s diagnosis is, and what the doctor prescribes, and produces a claim out of them using a form or software. The biller then forwards this claim to the insurance company, which assesses it and returns it. After the insurance is deducted, the biller reviews the returned claim and determines how much of the bill the patient owes.

What is the role of Medical Biller?

When the medical coder’s job concludes then the medical biller’s job begins. It is the medical biller’s obligation to prepare accurate, legal bills for the healthcare provider’s office and to transmit them to an insurance company, or payer, in a timely manner. It is also the biller’s responsibility to send and collect payments from patients. The following is a condensed description of the medical billing procedure.

A medical biller’s day consists of a variety of processes. The medical biller is in charge of preparing accurate, officially correct claims, double-checking transaction data for accuracy, and creating invoices for patients.

First, the medical biller takes the codes from the medical coder and produces a medical claim, either manually or with computer software. A claim is an itemized list of procedures, services, and prices that is delivered from a healthcare provider to a payer in order for the provider to be reimbursed.

This technique, while simple in theory, can be extremely difficult in practice. First, the biller must ensure that all of the codes are correct. Consider this a quality control check once the medical coder has finished their report. This necessitates that the medical biller be conversant not just with medical terminology, but also with the most recent versions of CPT, ICD, and HCPCS codes.

Medical billers must also become acquainted with the patient’s insurance policy in order to assess whether the procedures and services provided by the healthcare provider are covered under that patient’s plan. Essentially, the medical biller must ensure that each code and, by extension, each operation indicated on the claim is billable. This is usually determined by the payer and the contract that the healthcare provider or patient has with that payer. Each insurance company has its own set of regulations or guidelines that govern what can and cannot be billed for under the policyholder’s contract.

Erendiz Academy and Certified Professional Biller Course:

If your search is to find best medical coding institute near me, then reach out to Erendiz Academy.  Erendiz Academy being the good medical biller training institute for CPB online and classroom training in Hyderabad, Vijayawada and PAN INDIA, aims to give you with the best training to pass the CPB certification exam with a high score. The Certified Professional Biller certificate prepares medical billers to manage all areas of the revenue cycle from beginning to end. Healthcare provider reimbursement may not be jeopardized with knowledge in medical billing and the subtleties of payer regulations. The medical billing credential is critical to the financial success of the professional healthcare services claims procedure. By becoming CPB certified, you will learn how to submit claims in accordance with government regulations and private payer requirements. Medical billers check on the status of claims, resolve claim denials, file appeals, post payments and modifications, and manage collections.

Obtaining a CPB credential demonstrates that you have:

• Sound knowledge of various types of insurance schemes
• Expertise in applying payer policy, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for successful claim submissions
• Understanding of CPT®, ICD-10-CM, and HCPCS Level II coding guidelines
• Successful navigation of healthcare industry rules and regulations such as HIPAA, False Claims Act, Fair Debt Collections Act, and Stark Law
• Knowledge of the life cycle of a medical billing claim and how to improve the revenue cycle

AAPC new CPB Exam Structure:

• 135 multiple-choice questions (proctored)
• 4 hours to complete the exam
• Open Code Books (manuals)
• 70% passing score required

Mode of Training

• Online
• Classroom

This Certified Professional Biller exam contains of questions Types of Insurances, Billing Regulations, HIPAA & Compliance, Reimbursement & Collections, Billing, Coding, and Case Analysis.