Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by healthcare providers, such as doctors, hospitals, and clinics. It involves translating healthcare services into billable charges and ensuring that healthcare providers are paid for their services.

Key Steps in Medical Billing:
 

Patient Registration: Collecting and verifying the patient's personal and insurance information.
 

Insurance Verification: Confirming the patient's insurance coverage, including what services are covered.
 

Charge Entry: Recording all services provided during a patient visit, often using specific codes like ICD (International Classification of Diseases) codes for diagnoses and CPT (Current Procedural Terminology) codes for procedures.
 

Claim Submission: Preparing and submitting the claim to the insurance company, either electronically or via paper forms.
 

Insurance Processing: The insurance company reviews the claim to determine what portion of the services will be paid based on the patient's coverage.
 

Payment Posting: The insurance company sends payments to the healthcare provider, and the amounts are recorded.
 

Patient Billing: Any remaining balance not covered by insurance is billed to the patient.
 

Follow-Up: Managing any denied claims, resubmitting claims if necessary, and following up on overdue payments.
 

Medical billing is crucial for the financial health of healthcare providers, ensuring they receive compensation for the services they provide.

CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) codes are standardized codes used in the medical billing process to describe medical, surgical, and diagnostic procedures and services.

CPT Codes:

Purpose: CPT codes are used to describe medical procedures and services provided by healthcare professionals.
Developed By: The American Medical Association (AMA).
Structure: CPT codes are five-digit numeric codes (e.g., 99213 for a general office visit).
 

Categories:
 

Category I: Represents procedures and services widely performed and approved by the FDA. These are the most common codes used (e.g., 93000 for an electrocardiogram).
Category II: Optional tracking codes used primarily for performance measurement (e.g., 3008F for BMI screening).
Category III: Temporary codes for emerging technology, services, and procedures (e.g., 0062T for heart assist system implant).

HCPCS Codes:

Purpose: HCPCS codes are used for billing Medicare, Medicaid, and other health insurance programs. They cover services, procedures, and supplies not included in CPT codes.
Developed By: The Centers for Medicare & Medicaid Services (CMS).
Structure: HCPCS codes are alphanumeric, consisting of a letter followed by four digits (e.g., A0428 for basic life support ambulance service).
 

Levels:
 

Level I: This level is identical to CPT codes and includes medical services and procedures.
Level II: Codes that cover non-physician services, such as durable medical equipment, prosthetics, ambulance services, and certain drugs and supplies (e.g., J3301 for an injection of Kenalog).

Differences:

Scope: CPT codes are generally used for services provided by healthcare professionals, while HCPCS codes cover a broader range of services, supplies, and equipment, particularly those billed to Medicare and Medicaid.
 

Usage: CPT is more commonly used in the private insurance sector, while HCPCS is more prevalent in government healthcare programs.