How does something like an x-ray become the bill that comes in the mail?
It's the product of medical billing, a decades-old process that technology has recently transformed.
It starts when someone gets hurt or sick and goes to the clinic or hospital. They fill out paperwork and see the doctor. Once the visit is over, administrators ship off insurance and visit details for processing.
Behind the scenes, medical coders assign each service a code. Those can include diagnoses, procedures, and treatments. These codes help determine how much the insurance company will cover.
They create a detailed, itemized list of services, medical codes, and co-payments and send it to medical billers.
The billers use the list to create what’s called a claim for insurance companies to consider.
Insurance companies can do one of three things.
· Accept the claim.
· Deny it and ask for corrections.
· Or, reject it entirely.
There are a lot of variables that go into how much insurance pays. Whatever the company doesn’t cover ends up in a bill in the mail.
The process is digital now and much faster than doing everything by hand. It also reduces the risk of human error, which could save Americans money.