Medical billing is a payment process within the United States healthcare system that is used by doctors and other healthcare providers and insurers to get insurance claims paid. This process involves a medical biller submitting claims, following up on unpaid claims and appealing improper denials with health insurance companies in order to receive payment for services rendered. Medical billers facilitate the claims paying process and are often viewed as an extension of the doctor’s office reimbursement process. Medical billers can work in a doctor’s office or in an independent third-party billing company. Medical billers are encouraged, but not required by law, to become certified by taking a certification exam, such as the CMRS Exam (Certified Medical Reimbursement Specialist) in which billers demonstrate proficiency in the medical billing process. Employers often require billing certification. 

History

For several decades, medical billing claims were submitted almost entirely on paper and many of the processes utilized in doctor’s and medical billing offices were manually performed. However, with technologically advanced improvements of medical practice management software systems, standardized electronic transactions, EDI, clearinghouses and payer portals, managing the payment process has become much more efficient. Additionally, when Congress mandated that doctors must submit electronic claims in order to be paid in October, 2003 under the Administrative Simplification Compliance Act, it created significant new opportunities for medical billers, software developers, clearinghouses and ancillary services related to the claims process. Physicians and independent third party medical billing companies have a lot more options to help them get claims paid more efficiently and in significantly much less time.

Medical Billing Services

In many cases, particularly as a practice grows, doctors and other healthcare providers outsource their medical billing to a third party known as a medical billing company. The main goal is to get claims paid with the least amount of resources and at the least amount of cost. Getting claims paid requires a significant amount of time and and continual education. It’s a big investment of resources because every payer has their own rules and nuances and it is hard for the staff in a busy medical practice to keep up with the daily changes as well as to follow up on unpaid claims. One of the biggest investments for practices is their billing software. An outsourced medical billing company can significantly reduce a practice’s overhead and direct expenses on things like the cost of continual education, computers and billing software, employee expenses and etc. Medical billers are experienced in getting claims paid quickly, so it makes good business sense for practices to outsource their billing to a medical billing company. Related services medical billers offer include compliance, training, credentialing, working on old unpaid claims and more.

Medical Billing Earnings

According to the U.S. Bureau of Labor Statistics, employment prospects for medical insurance billers and health information technicians in the medical billing industry are projected to grow 16 percent from 2022 to 2032, which is a much faster pace than the average for all occupations. The median pay was $58,250 for an insurance specialist in 2022.