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)

--222.64.214.234 (talk) 08:27, 9 April 2010 (UTC)
 * http://www.healthtechnologyreview.com/medical-billing-software.php

Info about commercial medical billing software....
Clicks® - Medical Information System - http://www.roshtov.com/ --222.64.214.234 (talk) 08:22, 9 April 2010 (UTC)
 * 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=

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)

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.

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)