Talk:Medical billing

Question on Content

It seems to me that this content should be strictly a description of Medical Billing and should not seek to describe or define terms unless they are being defined according to unbiased third parties. I would like some feedback from others on this who have more experience in a wikipedia rework. This page is needing some attention. Jpittman 17:39, 15 March 2006 (UTC)

Verification and Additional Sources Needed

All of these terms were moved off the page and need to be either placed into sections and/or verified using outside sources. Links that are advertisements for software companies/portals of 'certification or education'/other storefronts don't count.

What is needed here is some hard and fast data either from insurance companies or the government to really solidify these terms.

(copyvios, e.g. from http://www.microtrain.net/mod.php?mod=calendar&op=list_events&sortby=category&cat_id=84, removed by Melchoir 01:09, 13 May 2006 (UTC))

reconsideration

I would like for a neutral party to reconsider adding www.medbillingforum.com to the medical billing page. I added this before reading or (finding) the guidelines for links. It is a well constructed site, commited to helping medical billers gain information that can help them in their career. There is no fee or membership required. The onlytime a membership is required is if a person would like to contribute to a discussion, reading discussions and learning from them is registration free.

Thanks for any help on this matter.

Joe —Preceding unsigned comment added by Medbilling (talk • contribs) 17:49, 10 December 2007 (UTC)

GP's companion software....

• http://www.hcn.net.au/products/pracsoft/ —Preceding unsigned comment added by 222.64.214.234 (talk) 07:49, 9 April 2010 (UTC)

• http://www.healthtechnologyreview.com/medical-billing-software.php

--222.64.214.234 (talk) 08:27, 9 April 2010 (UTC)

Info about commercial medical billing software....

Clicks® - Medical Information System - http://www.roshtov.com/

• http://www.google.co.nz/search?hl=en&q=medical+billing+software+benchmarks+filetype%3Apdf&btnG=Search&meta=&aq=f&aqi=&aql=&oq=&gs_rfai=
• http://www.google.co.nz/search?hl=en&q=%22medical+billing%22+software+benchmarks+filetype%3Apdf&btnG=Search&meta=&aq=f&aqi=&aql=&oq=&gs_rfai=

--222.64.214.234 (talk) 08:22, 9 April 2010 (UTC)

Comment

Medical billing is a three way event not a two way one as described here. It's a triangle between the provider, insurance company and, yes, the patient. It is the patient's responsibility to verify that the procedures being billed to the insurance company by the medical provider were actually performed on them. —Preceding unsigned comment added by 76.106.168.45 (talk) 23:42, 1 November 2010 (UTC)

Medicaid Prior Authorizations for AODA Services

Is it illegal to require patients to pay for counseling if their Prior Authorizations for AODA services is denied? A more accurate term being used in lieu of medical billing is Revenue Cycle ManagemementCoriag (talk) 00:03, 16 February 2011 (UTC)

Spam sites

Someone needs to look over this page or make me editor. Indian spammers are spamming this page with their Adsense sites. — Preceding unsigned comment added by Formerteacherb (talk • contribs) 22:57, 2 October 2011 (UTC)

Adjustment upwards, discounts of ninety-plus percent, and the fate of the uninsured

I think it would be good for readers to have an explanation of why insurance companies adjust some charges upwards and discount almost all of other charges.

I went into a hospital in 2012 for replacement of some of the discs in the spine of my neck with bone grafts, a common procedure.

Here's how my insurance company, United Healthcare, adjusted and discounted charges in the hospital's bill:

• The hospital bills $935. Insurance company adjusts amount upwards 1,132% to $12,453.20 less my $200 copay: $12,253.20.
• The hospital bills $4,570. Insurance company adjusts amount upwards 137% to $10,846.80.
• The hospital bills $67,685.25. Insurance company discounts 98.5%, allowing $998.13.

Altogether the hospital billed $73,190.25. The insurance company discounted 67%, allowing $24,098.13.

I went into a different hospital on the opposite coast for a different type of surgery, to lessen the severity of sleep apnea, in 2010. The insurance company's treatment of the hospital's bill was similar.

My impression is a discount of 67% is, if not unheard of, extraordinary in ordinary business.

Why does this system of accounting depart so much from the ordinary–extraordinary discount percentages of total charges with adjustment upwards of some charges and discounts of almost all of other charges? The patient cannot know whether the accounting is right. The patient has no idea of the reasoning of this arcane, if not bizarre, system.

Do the uninsured end up paying these nominal charges? — Preceding unsigned comment added by 173.72.136.7 (talk) 15:17, 12 May 2012 (UTC)

There should be separate articles for the US versus general concept

Practically all content in this article is about the US. None of it has references so this article is not stable.

Most of this content should be forked into an article called Medical billing in the United States. Since there are no references I do not want to split this article. 01:21, 30 June 2015 (UTC)

The general concept is covered at both Clinical coder and Medical classification; however, this is not made clear and pretty much every article around the subject of coding in general need copywriting to some extent. Little pob (talk) 19:31, 3 February 2016 (UTC)

All of the Medical Billing described in this article is highly localised to the United States and does not apply in any other country. Billing is highly dependent on the health funding structures in any given country - the article as currently labelled / structured is highly misleading. — Preceding unsigned comment added by 109.155.234.99 (talk) 22:23, 19 August 2016 (UTC)

I have now rewritten the lead to reflect that this is about a US practice. Needs more references from an expert in the field though. As a UK coder, I've only seen this term used in reference to US healthcare. If the term is used outside of the US, the article should be re-written by those familiar with the topic.Little pob (talk) 08:21, 20 August 2016 (UTC)

Broken link

The link in reference #7 appears to be broken: http://fiscaltoday.com/realizing-affordable-healthcare-advent-medical-billing/ gives an error message: "Error establishing a database connection." 2018-01-29, 03:49 am EST. Sigfriedgold It doesn't look like there is an error any longer. XanderL

Potential lead improvement

This content was removed from the bottom of the lead for being entirely bold case and containing an external link: (I have unbolded and removed the external link)

Extended content

The medical billing process involves the systematic submission and processing of healthcare claims for reimbursement. It begins with the patient's visit to a healthcare provider, where the necessary medical services are rendered. Once the services are provided, the healthcare provider creates a detailed record of the patient's visit, including the diagnoses, procedures performed, and any medications prescribed. This information is then translated into standardized codes using the appropriate coding system, such as ICD-10 and CPT codes. These coded records are submitted to the insurance company or payer, along with the patient's demographic and insurance information. The insurance company reviews the claim, verifying the medical necessity and coverage eligibility based on the patient's insurance plan. After the claim is approved, the insurance company processes the payment, either directly to the healthcare provider or as a reimbursement to the patient. The medical billing process requires accuracy, knowledge of coding guidelines, and familiarity with insurance policies to ensure timely and accurate reimbursement for healthcare services rendered.

However, from skimming, it does looks like it might have potential to improve the lead paragraph. I can take a look at some point, but thought I should drop it here if anyone gets chance to get round to it first.

@Robertbenjmain: It is important to follow the guidance on WP:external links. External links are not an appropriate substitution for proper referencing. I want to avoid the hassle of going to WP:AN/I, but have already posted twice on your talk page about your external link use with no response. If you want help on using Wikipedia, there are mentors available and you can always post on talk pages. Little pob (talk) 08:57, 1 June 2023 (UTC)

...it might have potential to improve the lead paragraph... Lead has now been rewritten. I am not a medical biller or even a US based coder, so please review. 12:23, 1 June 2023 (UTC)

Wiki Education assignment: WikiMed Fall 2024

This article was the subject of a Wiki Education Foundation-supported course assignment, between 28 October 2024 and 22 November 2024. Further details are available on the course page. Student editor(s): Forrtmanx2 (article contribs). Peer reviewers: Theyangthang.

— Assignment last updated by Wendyxieyang (talk) 06:55, 22 November 2024 (UTC)

The current article provides a foundational overview of U.S. medical billing, covering essential terminology, coding, and reimbursement processes. However, as a "C"-rated article, it lacks depth in several key areas, particularly in historical overview, recent developments, regulatory changes, and technological advancements within the field. The introductory and historical sections are basic and would benefit from expanded information to capture evolving trends and provide historical context.

While the current organization is generally adequate, the article would be more accessible with clearer structuring and more comprehensive definitions to enhance readability for a wider audience. Additionally, although the information is accurate, it could be more up-to-date and reflective of current industry standards and best practices.

To improve the article, I propose the following updates:

• Expand the history section to include the origins of medical billing, the evolution of initial record-keeping systems, and the role of major stakeholders in shaping the field.
• Add a detailed workflow illustrating the medical billing process, from the initial hospital encounter to the issuance of the final bill to a patient.
• Incorporate recent developments in U.S. medical billing practices, including updates on regulatory changes and the impact of emerging technologies on the billing process.

These updates will provide a more comprehensive and insightful resource for readers, transforming the article from a basic primer to a thorough guide on U.S. medical billing practices. Forrtmanx2 (talk) 16:07, 12 November 2024 (UTC)

WikiMed Peer Review

Lead:

• Lead reads very well.

• One suggestion I would give would be to add more citations into the lead section to back up some of the points given

Content:

• History- Loved this section, really gave a broad view of the medical industrial complex and how we got here. I think adding a section on the current/upcoming landscape related to value based care, may be helpful for readers. • Billing Process- great detail on the medical landscape. Could also add a section on value based care in this paragraph

Tone and Balance:

• The tone and balance of the article is outstanding. Love how definitions are given throughout the article for terms that the layman may not understand.

Organization:

• The organization is clear, well constructed. I loved how you utilized sub headers to describe the billing process.

Images and Media:

• Not super relevant to the topic(due to its non-visual elements), but I greatly enjoyed the images already imbedded into the article.

Overall Impressions:

Excellent overall! Well written article on an important yet less taught subject.

Theyangthang (talk) 06:26, 16 November 2024 (UTC)