Medical Billing is the process of reimbursing claims from a health care provider for rendering medical care services. In medical industry, people are spending more time in getting their reimbursement. Due to which there is an increase in operational cost. To reduce the cost of service the practice management system is brought into practice. This helps health care and insurance companies to pay claims for the services rendered.

Medical billing assists in managing the entire process of managing billing needs. Due to delay and improper report the claims are settled at lower value than the value expected. Health care providers are facing increased challenges in regulations, reimbursements, operational costs and medical coding. The medical billing involves the following process.

Certification and Verification

List of Patient and a copy of the insurance and demographic details are sent either through email, fax or FTP. The tele calling members of medical billing call the insurance companies before the due date of appointment. The tests and surgeries are certified with the specified labs and these details are given according to the format prescribed by the hospitals.

Patient Demographic Entry

The specialists of medical billing will enter the patient details such as name, identification number, date of birth, email id, address, medical history and the details of insurance given during the visit of the patient. Long relationship patient details are updated as and when the changes are renewed on the records of Practice Management systems database.

Claims Submission

Claims are submitted both manually and electronically. There are different levels of quality checks conducted and will be approved by a very senior medical billing specialist. The approved and rejected reports are analyzed and the claims are settled.

Follow ups of Account Receivables

The claims are examined and according to the priority the claims are prioritized based on the age of the claim. There are periodic follow ups via email and phone from an insurance company to know the status of claims.

Tags: Medical Coding

This entry was posted on Thursday, July 8th, 2010 at 9:25 pm and is filed under Outsourcing. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.