The Medical Billing Process And Its Peculiarities
Medical care is the field which has been constantly developing. There are always some innovations announced and new discoveries made. This concerns not only drugs, but equipment, treatments and health care billing as well. The medical billing process is a very complicated set of procedures, which involves many people of different professions in it. The main aim and result of such algorithm, from medical care provider’s point of view, is to receive revenue for the services rendered to their patients.
A medical billing company worker comprises an intermediary link between a provider and insurance company. Their job is to prepare accurate billing forms and submit claims in order to collect payments. Generally, their revenue is the percentage charged from billed out claims. Along with billers, there is another person involved into the billing process – a medical coder. These are people, who are responsible for encoding services and procedures, which are mentioned on the patient’s documentation provided by a physician. When the services and diagnosis are filled, a medical biller submits a claim to the insurance company for billing. Actually, there are two ways of managing the billing. The first one is to hold the entire process in-house. In this case medical care providers use software to submit claims. The main advantage of this option is transparency – the possibility to maintain and operate patients’ data by themselves. Additionally, the risk of losing data is minimized, as it is not transferred via the Internet. If it is the second option, it means that your data will be managed by a third-party company, such as OHIP billing agents in Ontario. The only thing required is to transfer it using some EMR or EHR software. Usually, the best medical billing services, which work remotely, have private servers, which allow to encrypt and secure confidential information. When a medical care provider renders a service to a patient, diagnose and medical procedures are recorded, coded, and after that submitted as a claim to the insurance company. When such company receives a claim, it passes adjudication. After this step, there are three possible solutions: the bill may be paid fully, partially or the claim may be denied or rejected. Denied claim means that some data, such as patient’s personal data, needs to be revised and fixed, than the claim should be resubmitted. If the claim is rejected, it may happen because some procedure may not be covered under an insurance policy.
To sum up, the medical billing process is a very complicated algorithm of actions, performed by an in-house department or a third-party medical billing company. Both options possess their advantages and disadvantages, and it is up to a provider to choose which way is the best for them. Usually, the critical factor is the way a health care provider prefers to manage his/her billing: either to take everything under control or to trust it to a professional company and save their time.
