Facts About Insurance Billing & Healthcare Reimbursement

Medical billing and reimbursement is sometimes also called medical coding and billing. This is a very profitable and growing profession.

Medical Billing

• Medical billing is utilizing standardized billing and diagnostic codes to obtain money for a medical provider.

CPT Codes

• Current Procedural Terminology codes are used to report medical procedures performed by doctors. There is a code to describe every procedure a physician performs. These codes are universal and must be used for proper reimbursement.

ICD-9-CM Diagnosis Codes

• ICD-9-CM diagnosis codes are used to report the symptoms and conditions that an individual is experiencing at the time of the doctors visit.

ICD-9-CM Procedure Codes

• ICD-9-procedure codes are used for facilities to report surgeries and other outpatient services. These are used separately and in addition to ICD-9-CM diagnosis codes.

Diagnosis Related Group

• The Diagnosis Related Group is used for inpatient hospital bills. It bundles all charges into one fee associated with the DRG, and this determines the payment that the facility will receive.