What are the components of Medical Billing?

The following are the components of Medical Billing:

(a) Patient: A person who receives healthcare services from a physician is called patient

          There are two types of patients.

          New Patient: Any patient who is visiting the physician for the first time or subsequently after a break  exceeding the period of 3 years is called a new Patient.

          Established Patient: An established patient is one who is visiting the Physician within a period of 3  years from the date of his last visit.


(b) Provider: Any Healthcare professional (i.e. physician, registered nurse, therapist, etc.) who provides medical-related services to the patients.

(c) Insurance Company: This is the company, which takes care of the subscriber’s dependent’s healthcare costs.

(d) Billing Company: These are the third party offices which will take care of complete billing activities of providers/hospitals. In other word, these companies will manage financial data of physicians.

(e) Coding Agencies: There are two major agencies involved in coding. They are American Health \   Information Management Association (AHIMA) and American.  Association for Professional Coders    (AAPC), these associations set standards and Procedures for Coding.

(f) Transcription Agencies: There are lots of transcription agencies involved in billing Industry. Either these will be run as a separate entity or it runs in provider office itself.

(g) Clearing Houses: It is also referred to as Third Party Administrator (TPA). It is an entity that receives claims that are transmitted, separates the claims and sends each one to the correct insurance payer.