What are the functions of a Billing Company?

A Billing company gathers patient information like Insurance details and charges details from the provider/physician and submits the claims to insurance carriers for payment. The major functions of Billing company are:


Coding Department: Medical Coding is the process of assigning a code for Medical Diagnosis or procedure. This will help the doctors/providers, nurses, or hospitals to get proper payment from the insurance companies. People working in this department should be well versed with Medical Terminology, Anatomy, physiology, etc.

Demographics Entry: All-patient’s personal information like patients’ Name, DOB, address, Phone #, guarantor name, employer details, Insurance details will be entered in the billing software.

Charge Entry: Charge entry executive will create charges/claims for the patients based on the CPT and DX codes given by the coder and on billing rules pertaining to specific carriers and locations. All the charges should be created generally within 24 hours. A though audit and checking of the completed medical claims is done at multiple levels.

Transmission of Claims: Once the charge entry/Audit is over, claims will be transmitted to the Clearinghouse (For few insurance companies, we can directly submit the claims to them and we don’t have to go thru a clearinghouse).

Cash Posting: Once the insurance process the claims, they will issue payments. Payment posting executives will post the payments in respective patients’ account.

Insurance Calling: Following up with the Insurance companies on pending claims & denied claims.

Patient Calling / billing: Following up with the patients on their outstanding Bills, Coverage clarifications, etc.,

Center (Hospital) Calling: Contact the hospitals for clarification relating to treatment, Doctors, Authorization, Medical Records, etc.