Billing Process Under The Medical Billing Software

Many people dont understand how a certain hospital is billed or how it is being claimed by the health care provider

. A lot of us dont care, mainly because we are paying the insurance companies to take care of such business. But to better understand how useful a Medical Billing Software is, the knowledge of the billing process is largely required. Before you strangle your insurance agent as to why your health care provider rejected your insurance policy, get to know first the steps to payments, claims and reimbursements.

The billing process: how it works

The medical billing process if an interaction between the health care provider and the insurance company. This was mostly done by papers before, which always resulted to delayed payments of claims and reimbursements. Thankfully, the entrance of Medical Billing Software has made it a lot easier for health care provers and insurance companies to transact billing statements and payments.

The interaction between the health care provider and the insurance company starts when the physician or his/her staff creates a medical record for a patient. This record contains the summary of treatment and the demographic information such as the patients name, address, contact numbers, social security number and their insurance policy identity number. Other information that may be included there are the nature of the illness, the diagnosis, the examination details, list of medication and suggested treatment.

These things will then be evaluated by a medical officer. This evaluation will determine the level of service that will be used to bill the insurance company. Once all the information is in the records, it will then be submitted to the insurance company for claims. This is now done electronically or through the Medical Billing Software, which can allow the insurance company to counter check whether there are discrepancies in the records.

The records and the claims will be evaluated by medical examiners or medical claim adjusters to see if the insurance policy of the patient covers such expenses. Once the evaluation is done, the insurance company can either accept, reject or deny the claims. Once it is approved, the payment will be processed and will be sent in a couple of weeks.

However, if a claim is denied, this means that there is something that the medical claims adjuster was not able to reconcile. The physician or the hospital can appeal this particular claim numerous times until a deal is broken between him/her and the insurance company. If, on the other hand, a claim is rejected, this should be corrected and resubmitted. A rejected claim cannot be appealed because it has not been processed. Rejection of a claim is usually caused by wrong information on the records.

A Medical Billing Software has helped hospitals and insurance companies streamline the process of payments of claims and reimbursements. It has significantly raised the bar of excellent services and easy partnership between a medical institution and an insurance company.

by: Kris Vanegas

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