Medical billing is the process of submitting the claims to insurance companies in order to receive money for the service rendered by a healthcare professional. Before treating and billing a patient, healthcare providers check the eligibility of the intended service with the insurance company electronically. The insurance company has medical directors, who review the claim to check the validity of the payment based on the credentials of the care provider and the necessity of the treatment. A response to the eligibility request is returned by the insurance company through electronic means or more commonly from their website. Proved claims are reimbursed up to certain percentage of the billed amount. Failed claims will be rejected and the healthcare provider will be notified.
Since 1997, all practices which involve patient interaction should pass HIPAA, the Health Insurance Portability and Accountability Act. Under HIPAA, most of the billing claims for the service are required to file via electronic means. HIPAA was enforced in order to prevent fraud and abuse in healthcare delivery and health insurance. While manual filing is time consuming, electronic billing is fast and accurate. With the usage of electronic billing, the rejection and denial has reduced drastically and the percentage of reimbursement has improved.
Electronic medical billing is nothing but the combination of IT and health care sector. Medical practices have been using software to manage their finances for several years. However, the present electronic medical billing programs are well known as medical management practice software. Electronic medical billing software covers a wide range of functions including tracking patient demographics, scheduling appointment, tracking billing information and insurance payments, patient's visits, diagnosis and generating records.
Electronic billing is easy to use, thus helps the staff to improve their productivity.
So, in total, electronic medical billing was a result of combined effort of software companies and healthcare departments to invent a new technology to simplify the process of medical billing.