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What is Insurance Billing?

An Explanation of Benefits shows the copay and deductible amounts that are an insurance policy holder's responsibility.
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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 03 August 2014
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Insurance billing is the process of submitting paperwork and documentation to insurance companies with the goal of getting the insurance to pay out a claim. In the medical community, insurance billing is often a huge part of the office paperwork, and some offices actually hire billing specialists who spend all their time submitting paperwork to insurance companies. Health care providers must be knowledgeable about the process in order to ensure that their claims are paid.

Several colleges offer coursework in insurance billing for the purpose of certifying people who want to work in this field. These courses include introductions to anatomy, common medical terms, and medical procedures, along with a discussion of the complex claim forms used by insurance companies. Insurance billing specialists also need to learn about the thousands of codes which are used to identify various procedures on claim forms.

Medical offices, hospitals, and clinics provide insurance billing as a service to patients. Typically, the bill is sent to the insurance company first, and if there is an unpaid balance, it will be submitted to the patient. Patients can opt to pay the balance, or dispute the claim with the insurance company in the hopes of getting the insurer to pay a larger share of the bill. Billing can get very complex, especially in the case of a patient with several medical conditions, making it impossible for most patients to handle insurance billing on their own.

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Many insurance companies work with billing software. Once people learn to use the software, it can streamline the billing process, as everything can be submitted very rapidly via electronic means. Otherwise, it will be necessary to fill out numerous forms and items of paperwork, each of which must be filled out exactly right, or the insurance company will reject the entire claim without even bothering to evaluate it. Patients should be aware that insurers would prefer to reject claims whenever possible, so a rejection should be viewed as the first step in a negotiation, not a final decision.

In a large facility like a hospital, maintaining an insurance billing specialist is logical and often vitally necessary. Smaller health care providers and offices may maintain a roving billing specialist who contracts out services to several offices. A massage therapist, for example, might opt to contract someone else's services rather than navigating the tangled web of insurance billing procedures. Using an independent contractor can save time and money for people who have not received training in insurance billing procedures, and this can also benefit patients, because using an expert ensures that claims will be more likely to be accepted and paid.

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Discuss this Article

collinsjacob
Post 5

Let me explain it as simply as possible. Every time someone visits a doctor's office, they fill up a form with their health insurance details. These forms are submitted by the healthcare facility to the patient’s insurance provider, which then verifies them and releases the payment for the medical services received by the patient. This entire process is called insurance billing.

Obviously, there are people who are hired to do this job and they need specialized skills to perform it. These days, insurance tech companies design billing software that makes the job of a billing specialist easier by streamlining the process and also helps in cutting costs as well as enhancing customer experience for the carriers.

collinsjacob
Post 4

Like the article explains, insurance billing is the process of submitting documentation that leads to a claim pay out or settlement. Since this involves actual disbursement of money, it is also considered one of the most important functions in the insurance industry. Tech companies build insurance billing software to streamline the process, rationalize costs, as well as improve services and customer experience.

tsagar
Post 2

This is a very limited definition. Insurance is a lot more than simply health claims. As such, insurance billing would also mean a lot more than what this article indicates. In a wider - and truer - sense, insurance billing is premium invoicing. When an insurance deal is struck between a buyer and a seller (insurance company), the latter raises an invoice on the former. This is the real insurance billing.

What this article describes is merely 'health claims billing'. It would be appropriate to modify the title of this article. --Sagar

anon61443
Post 1

Yes, it's a process of submitting bills or claims to insurance and getting paid for that. It's a complication process, to know in detail.

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