25 Nov Choosing the Right Medical Billing Team
When medical billing and coding work in a seamless fashion, it may seem as if the process itself is simple, but it is an intricate set of processes for specialist professionals who translate the data and ensure that accurate billing and claims are made. The patient has a direct interaction with the medical professional during treatment sessions but, as a healthcare provider, there are three definite parts to the process and these are aspects unseen by the patients.
Firstly, the patient. Once treatment commences and all data is added to and updated by the healthcare provider, coding takes place which is where all the doctor’s information regarding their patients are translated into specific codes. All medical outlets and professionals including doctors, emergency rooms, and outpatients’ facilities follow the same processes. Then, the final part of this link is the insurance company and the bills are paid subject to the relevant insurance cover.
The medical billing specialist negotiates between all three and this is where knowledge, a keen instinct for the job and being able to focus on the task at hand is vital. The medical billing specialist ensures that ultimately, the healthcare provider receives adequate compensation for the services they have provided and so, information about a particular patient, the procedure etc. is compiled into an overall bill known as a claim. The claim is then sent to the relevant insurance company. It is not a standard invoice for services but contains detailed notes about demographics, insurance coverage and of course, the medical history of the patient in question.
There are different types of insurance including indemnity where the patient has the option to choose any provider although this is usually more expensive but does provide much flexibility for the patient. There are consumer-driven health plans and managed care organizations and although patients have less flexibility, costs are fixed and therefore, are usually lower. Every type of insurance has specific procedures. Some services will be covered and others not, and this is where the complexities come in to play. The medical billing specialist has to fully comprehend the insurance plans for each patient and work with this to ensure an accurate claim is made. Understandably, there is some overlap with medical coders but, once coding is complete, medical billers take these diagnosis codes and the claims are then crafted to match individual needs.
The medical biller calculates the balance, deducts insurance payments and will consider any other deductibles. They must also take all relevant information from the patient’s personal medical records and their insurance plans. Some healthcare companies may prefer to have their own employees managing the billing and coding service, but many health organizations have elected to outsource this aspect and by choosing the right company, have saved money, have streamlined the whole process and ensured that every legal update, changes to procedures and any compliance issues are adhered to without any issues. Within any health organization, there are naturally demands on time which is not just relevant to the work itself but is still a vital part of the process i.e. that of keeping one finger on the pulse of legislation. In addition, sometimes there are delinquent bills where collections have to be arranged so to ensure the outstanding debt is taken care of. A medical biller is consistently communicating with patients, healthcare providers, insurance payers and clearing houses. They chase up and organize the whole reimbursement process. If this is of interest, then there is more information on outsourcing the medical billing process here: Medical Practice Management Resources.