HOSPITAL MEDICAL BILLING DEPARTMENT
Depending on the size of your medical facility you will probably have a separate hospital billing department. This department may even be divided by types of insurance billing and/or paper claims and electronic claims. Today almost all billing is done electronically. In fact, quite a few will not even accept paper claims anymore. So, that means that hospital billers must be familiar with not only the paper UB-92 but the electronic version as well. Paper claims are still printed or downloaded into an imaging program for later printing as they are much easier to read than the electronic file version. For those who still have paper financial files these printed electronic claims on the UB-92 are filled with each patient's encounter.
Hospital Billing is a little bit more complicated than doctors office billing in that there are more codes and more boxes to fill out on the form. The biller is mainly responsible for printing off the forms, releasing the claims for transmission and correcting code edits that prevent the claims from going to the insurance company electronically. They are generally not responsible for the actual coding as that is usually done in Medical Records by certified coding personnel.
Once the claims have cleared through the electronic billing system and gone to the insurance company all the biller is responsible for is to clean up the claims that have to be sent via paper. Some may include, secondary billing that requires a copy of the EOB from the primary insurance, Workers Compensation billing that usually requires medical documentation to accompany the claim and some Commercial bills that cannot go electronic and may need a claim form from the patient.
Should the claims get rejected for any reason or the insurance company states the bill has not been received electronically then the billers are assigned the task of correcting what information they can on the claim, gather whatever documentation the insurance company requires to process the claim or just rebill the claim to the insurnace company.
The workload is wholely dependent upon the amount of discharges from the previous week and when the Medical Records Department releases the claims from their department for billing. Outpatient and ER claims are usually dropped by most systems within 7 to 10 days. Inpatient claims cannot be dropped until the patient actually discharges from the hospital and ALL of the required documentation has been received, signed and coded. In some cases, when the patient has been in the hospital for more than 30 days, an interim bill will be dropped by the system. These may or may not be sent out depending on the insurance company policy.
For the most part hospital billing is a tedious job that requires the biller to do the same tasks day after day in the prescribed order. The actual job is dependent on the medical facility itself, what computer systems they use for billing and how fast the medical records department can process the coding and other requirements for each claim.
***NOTE*** Once a claim is billed your system should have a way to make a note of the date, amount of claim and the insurance company it was billed to. This is important documentation for the Insurance Follow-up People. IF you system does not have that capability then someone should be assigned to key that note in manually!