Thursday, 1 March 2012

Medical Billing

Seeking new opportunities as full time/part time/consultant, Please email me at at

I strongly feel that Development of PMS Product is more on the domain/business logic other than the technology. So would to like to share the information in PMS thru my blog.

There are lot of articles/books/document sitting on my desk which I have collected from various sources for the past 10 years. From that, so I will try to educate on that in a simple and easy to understandable way with an example when necessary. Looking for best Practice Management software ? Please email at

Chapter 1: Medical Billing Workflow
1. Medical Billing Use Case

Chapter 2: Medical Billing Process
1. What is Medical Billing Process ?
2. Different Format of Medical Form.
3. Patient Insurance
4. Electronic Claim Transmission
5. Medical Billing Clearing house
6. Medical Billing Process in detail
7. Healthcare Coding system.
8. Maintaining Patient Insurance in the software.
9. What are the Billing Entities ?
10 What is Pre Authorization.

Chapter 3:  EDI Transactions

1. What is an EDI ?
2. EDI Transactions 

3. Understanding EDI Structure
4. EDI Instruction
5.  Difference Between 837 Institutional and 837 Professional
6. EDI 5010 Documentation 837 Health care claim : Professional
7. EDI 270 - 5010 Health Care Eligibility/Benefit Inquiry

Chapter 4: Payment
1. EOB – Explanation of Benefits
Understanding EOB - Explanation of Benefits
3. Understanding EDI 835 Electronic Remittance Advice
4. What is Copay, Co Insurance and Deductible in  Insurance Payment Posting ?

5. Types of Reimbursement
6. How to process Co pay, Co Insurance and Deductible Amount in Insurance Payment Posting ?

Chapter 5: Claim Submission after Primary Insurance
1. How to submit the claims after primary insurance ?

Chapter 7: Claim Processing by the insurance company

1. Claims adjudication and Payment process.?


New to Health care Domain ?  Here are some documents which can help you to understand the basics.  I am trying to refer to official link(where i downloaded the document)   and as well as link to my server(some time, official links are broken).

1. Introduction_to_Health_Care_in_USA   (or you can click here to download)
Medicare Incentive Program Beginners guide MU Stage 1 ( or you can click here to download)

All about Prescription

Flow charts

Medical Billing blogs

EDI 837 P Budget Number Example