Medical Billing

Medical billing is a procedure of billing and collecting fees for medical and healthcare services rendered to the patients’ .It is the process of submitting and following up on claims to insurance companies in order to receive payment for services given by a healthcare provider. Generally this is an interaction process between a healthcare provider and the insurance company.

The process for Medical billing follows the below algorithm with complete focus on accuracy and the quality provided to the patient.

1. Insurance Verification and Authorization: The process begins at front desk wherein the patient insurance information is collected either by phone or fax or in-person(if the patient is a walk-in).The collected insurance information about the patient is immediately verified and authorized relative to the care, the patient is seeking.
2. Patient Demographic Entry: The complete information of the patient is entered accurately.
3. CPT and ICD-9 Coding: It is essential for Medical billing, the coding system describes medical and surgical procedures and services performed by physicians and other health providers.
4. Charge Entry: on the requirements of the patient, audit process which ensures the accuracy of the entry based has to be done.
5. Claims Submission: claims can be either paper or electronic claims. for postage and mailing, the paper claims are printed and inserted into envelopes and sent. Emails are sent as electronic claims.
6. Payment Posting: After processing a medical insurance claim, the medical insurance company administrators issues a check and prepares the explanation of benefits (eob).
The eob explains the total amount the health care provider billed for medical services rendered to the patient, the amount paid under the insurance contract, and who was paid.
7. A/R Follow-Up: Account Receivables must be followed up in order to receive the payment for the services provided to the patient from an insurance company.
8. Denial Management: some times the claim is denied, the reason for its rejection is analyzed and an appropriate action is taken against the cause of denial.
The process for payment of the rejected claim is done; a list of the payment details related to the claim is compiled.
9. Reporting: Patients are advisable to maintain a report of their bills from the health care provider of medical services, so that if any problem arises they can compare the report with explanation of benefits notified by the medical insurance company administrators.

Health Care fraud, Inaccuracies in submission of medical claims, Non-conformance to all existing Federal, State and Insurance Company regulations, Stringent Compliance requirements are few of the common concerns which has to be taken care during the billing process.

Hence, the medical billing process includes the above well-organized phases followed correctly for high-efficiency and cost control.