Professional Medical Billing Services
The sad fact of the matter is that in spite of America being a first world country and all its attendant luxuries, it still boasts of the most expensive medical and healthcare costs in the world. There are a myriad of reasons for this but the main reason might be due to several inefficiencies in the system. With each additional level of payment, the healthcare seeker incurs additional costs.
This is where professional medical billing services comes in, it is an attempt to have a central point via which all patients payments are processed. So what is medical billing? Medical billing is the process through which a service offered by a doctor to a patient is transformed into a billing claim. This is a pretty straightforward process, since as a doctor if you fail to do the billing through filling a claim then you will not get paid for the services rendered.
As a doctor looking to engage professional medical-billing services, there are a couple of things that you need to watch out for if you expect to have an efficient service provider, to get the best value for buck;
- Insurance Verification–Naturally the first step involves the registration of the patient the moment they present themselves to the hospital or health center. At this point the service provider will try to ascertain the entity that will be responsible for payment. After which the service provider analyzes the insurance coverage, verifies it and prepares accurate billing forms.
- Demographic and Charge Entry–This is an extension of the patient check in in which the charges due to the patient are confirmed, that is the payer of the bills is confirmed and that information is logged and confirmed. It also extends beyond the patient check-in (demographic info and medical history) as described above as it also covers the patient check out information.
- Claims Submission – The next step after collecting all the above required information is to get to making sure that these bills generated actually do get paid. This is done by filling claims to the entity responsible for payment. The service provider makes a point of ensuring that the claim meets the set standards of compliance, both for coding and format.
- Payment Posting and Follow-Up–After submitting the claims the service provider must have the capacity to have it prepared in the proper manner and present it for adjudication. In adjudication the payer evaluates the claim for settlement and if they find it compliant then they settle the claim accordingly.
Reporting and Denial Management are closely linked to the above mentioned point namely payment posting and if the claim is found to be wanting then the payer will return reject the claim in order to have it presented in the proper manner with all the pertinent information included. Ideally as a medical practitioner you want to engage professional medical billing service providers who have atrack record of getting everything done in the proper manner at first strike.
Saheen Mouwdry is a medical billing expert who runs a firm that specializes in this field. He has been active in the space for the past 28 years in which time he has engaged more than 15 major hospitals as their primary billing provider.