How To Achieve Successful Medical Billing In Your Practice

With todays unrelenting economic pressure, top notch billing and collection systems

are a key component of any medical practices foundation and stability. This was foreign to me until I did some research to write some simple yet extremely important steps in the medical billing and collection process.

Medical billing is a specialized process that involves submitting practitioner insurance claims. Additionally, continual follow up on the insurance company claims is critical to ensure expedited receipt of payment for the services provided by the medical specialist or health care provider. Regardless of whether the insurance company is private or owned by a government entity, the submission process will be the same.

The insurance company, also known as the payer, will process a claim. Medical directors within the insurance company will review the claims. The medical director will review the claims and decide whether the claim has a legitimate case for payment. In deciding whether to remit payment to the provider for the claim, Medical Examiners will look at the providers credentials and the medical necessity of the claim. Approved claims are reimbursed for a certain percentage of the billed services. Failed claims are declined and the insurance company notifies the provider of the failed claim. In most cases, the insurance company does provide reasoning and potential corrections for the claim.

This is the point that things can get tricky. A rejected claim will result in the medical provider choosing whether to reconcile the claim with the original claim, or whether they need to correct the information in the claim and submit it again to the insurance company. The submittal, decline, resubmittal process might occur several times before a single claim is paid. And in some instances the claim may never be accepted for full reimbursement. Rather, the practitioner would need to determine at what point a partial reimbursement would be financially acceptable. Clearly, there are many opportunities to optimize the claims process for the medical provider. This is where a highly qualified medical billing company is a critical partner in helping navigate the claim waters to maximize reimbursement for your practice.

Medical billers and collectors jobs within medical billing companies are positions that require accurate and detailed claim processing. The billers and coders have to be knowledgeable on what a claim consists of and what additional information is needed to include with the claim to avoid unnecessary delays or failures in the processing of the claim. Insurance Companys earn lots of money through the claims that they do not pay. Reference and support material is very important to have on hand to make sure your claims are accurate. Mistakes can be made on claims through incorrect data entry. Having a good reference guide can help avoid some of those mistakes.

Medical billing, coding and collections require a skilled professional organization. When processing medical claims you must be confident your biller will check every last detail of the submission, properly itemize the medical documentation, make pertinent notes and securely submit each medical billing claim.

As you can see even in the simplest terms medical assistant billing and collections is the most important and cost effective health care service for size medical data entry business.

ProAssist understands that effective, strategic medical billing can be quite time consuming. We have grown to become a national leader in this industry. We are intimately familiar with all major insurance changes and regulations, as well as state and federal payer guidelines. We will customize an aggressive billing strategy for you that will give you the confidence to know that everything is being done to successfully collect your hard earned income.

by: Proassistsa

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