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Revenue cycle component – translating a “service” to a “claim form.”

Updated by HCRL Admin on 10/29/2014


ARTICLE WRITTEN BY:

Marcella Johnson

Medical billing translates a health care service into a billing claim. The responsibility of the medical biller in a health care facility is to follow that claim from billing to payment to ensure the practice not only receives reimbursementfor the work the physicians perform but an accurate payment from the payer. A knowledgeable biller can optimize revenue performance for the practice. 

Although a medical biller’s duties vary with the size of the physician’s practice, the biller typically assembles all data concerning the bill. This can include charge entry, claims transmission, payment posting, insurance follow-up and patient follow-up. Medical billers regularly communicate with physicians and other health care professionals to clarify diagnoses or to obtain additional information to secure payment. It is important that the medical biller has the ability to interpret medical record information and, like the medical coder, be familiar with CPT®, HCPCS Level II and ICD-9-CM codes.


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