Medical Billing- A Modern Definition

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The moment asked about the goal of medical billing, most people answer that this is available to get doctors paid. But physicians get compensated regularly in some countries which may have no medical billing. Therefore the conventional wisdom goes, if getting paid was the only reason for medical billing, it should be relatively easy to eliminate it and even save more amount of money. Although medical payment does get physicians paid, its function is significantly larger. You may get directed to for info on anesthesia billing.

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What is the role of Medical Billing today?

In finance, the efficient-market hypothesis claims that financial markets are "informationally efficient " which means that the prices reflect all the info available to the market participants. A great industry efficiency mechanism records and gives all relevant information to the market participants.

Medical billing is a healthcare market efficiency mechanism that

  • ensures treatment quality,
  • documents treatment,
  • reins in uncontrollable physicians, and
  • offers patients alternatives.

Rather of writing payment protocols for each and every possible patient, we have codified medical diagnosis and treatments. These two sets of codes along with a mapping system of the codes to the payment schedule allow us to test if appropriate tests and remedy are performed for a given problem. Further, the units of codes and the mapping system are digitized, allowing fast processing of vast amounts of information.

This mapping system easily identifies physicians who practice outside of its anticipations. Medicare and insurance companies verify treatment adequacy to problems employing this mapping system, often called billing guidelines.

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