What is Medical Billing Really Is & How to Do It?

What is Medical Billing Really Is & How to Do It?

Medical billing covers all the activities required for doctors or other healthcare practitioners to get paid by either the patient or reimbursed by an insurance carrier. Most apparently it involves the preparing of medical claims to be sent to health benefit payers such as Medicare, Medicaid, Blue Cross or Blue Shield, etc. 

Submitting medical claims to an insurance company and managing the overall claim process is more complicated than filing someone's Taxes; as there can be more than five different entities sharing the responsibility to pay for the medical treatment of a patient! 

While it can take time and experience to become a good medical biller, it's helpful if one begins with a clear grasp of what a 'Medical Biller' is supposed to do, and how they are supposed do it. This series of ten articles takes an in-depth view at how the best medical practices view, organize and execute the tasks associated with the entire medical billing process. For folks who like diagrams, here's a easy schematic depicting just how involved the whole medical billing revenue cycle can be

#1   Checking Eligibility #2   Understanding Coverage #3   Check-in (administrative) #4   Medical Coding Essentials #5   Sending Claims Electronically

#6   Revenue Cycle Management (RCM) #7   Follow-Up & Adjudication #8   Pay & Adjust, Secondary Claims #9   Denials & Appeals #10  Collections

# 1  Why Eligibility Verification Matters ?

As a Medical Biller, your objective in per-screening insurance eligibility is to determine patient responsibility before check-in; ideally, before the patient ever leaves their home to go to their medical appointment. You need to know what's covered and what's not, preferably before the patient arrives.

# 2   Benefits Coverage (for dummies)

Why does every single insurance carrier report different information and report it in a different format? Making sense of health insurance benefits means the difference between getting paid or not getting paid. Here we seek to unravel the mystery of understanding benefit eligibility reports.

# 3  Do's and Don'ts at Check-in / Handling Cash

So much can go so right, and so much can go so wrong, at check-in. Clear policies and adherence to those policies are the key to success. In good practices you'll see many common denominators. Here are a few of them.

# 4  Claim Preparation / Medical Coding / Coding Utilities

Nothing pays like experience and it is doubly true when you begin preparing claims for filing. Medical Coding is synonymous with who and what a medical biller is. Here are a few thoughts from veterans of the craft.

# 5 Filing Claims Electronically / Scrubbing for Errors

Everything you never wanted to know about claim transmittal and claim errors!

# 6 The Claims Have Been Sent, Now What?

Once a claim has been sent, it kicks off the revenue cycle and the sand of time begins running down the hour-glass. Here's the nuts and bolts of RCM, and how smart billers organize themselves and their tasks.

# 7  Adjudication, Follow Up, Submittable

Adjudication, insurance follow-up and avoiding claim resubmit, could be considered the necessary core competencies of a Medical Biller. Here's what all three are about and how to do them.

# 8 Payments, Adjustments, Secondary Claims

A Medical Biller needs to enter Payments & Adjustments as soon as payments come in so that Secondary claims can be filed in a timely manner. It also provides the practice with current status on patient balances and insurance balances, which is needed to manage cash flow.

# 9 In a Perfect World

Let's face it, insurance companies increase their profitability by denying claims and sometimes they'll deny them out-of-hand for no legitimate reason just to manage their cash-flow. So if you have a health benefit payer that insists on a fight, well then let's roll up our sleeves; here's what to do.

# 10  Patient Balances : Statements, Payment Arrangements, Collections

As a Medical Biller your aim is to avoid ever having unpaid patient balances in your account receivable reports, but in the real world, here's what to do when you inevitably get them, and expert advise on how to avoid them.

Precondition Medical Billing Mechanism

Health care billing companies might help increase the earnings, and reduce the expense of health care professionals with a great extent. The education which health health care professionals receive is actually primarily concentrated on the medical specialty. Most doctors cannot treat patients as well as manage the charging and accounting of these practice simultaneously. Hence the need to outsource this work to medical payments companies.

Medical payments companies free an individual from managing your own billing, accounting, along with filing claims. Thus giving a boost for your medical practice the way it frees you to target serving your patients and attracting more business.

The fees of the billing company you decide should be all-inclusive. There should be no hidden expenses. The company you decide on should be using advanced medical code and billing computer software, and update their particular software regularly, in order for it to conform to the latest medical billing foibles.

How can you find a very good billing company to your billing/accounting needs? The testimonials that a lot of companies offer you are probably not the simplest way to judge the corporation's efficiency. What should the company provided you because of their best testimonials, and not with the modest or negative kinds.

When you are searching for your billing business, take the following note: How long have they been in business and what's their track document? How experienced can be their staff with medical billing and also recovery? How quickly do they solution your questions? Medical billing has to be done in the time-efficient fashion. So it is advisable to note responsiveness on the company, in situation you asked these individuals any questions. What's their claims' negotiation rate? Industry average claims' settlement rate for most companies is 20%-30%, anything under this number (such being a 10%-15% settlement rate) is actually good.

There tend to be more than 7, 000 medical billing companies in the united states, and counting. Discovering the right one for may very well not be easy as a result of large number of companies in existence. However, this abundance also provides you with a lot of preference and options to switch even to another company if you aren't satisfied with your billing company.

You have to ensure that this company you pick gives you a complete answer. Merely following high on your claims is not sufficient. The best billing companies provides you with full access for your data and quickly receipt of affected person money. The top-notch companies will promise your results.

The staff of your potential billing firm includes billing in addition to coding experts, process engineers in addition to technologists (in order to counteract any errors also to overall streamline the complete billing process). Busy doctors will need billing companies that can help them increase their particular returns and lessen their expenses while they concentrate on serving their patients. It's a perfect solution to have an overworked medical skilled.