What is Medical Billing?

It’s the process by which medical claims are submitted to insurance companies and patients so medical providers can receive payments for providing services to patients.

Medical claims:  These are statements that list service and their fees, as determined by a provider.

Insurance companies: medical claim payers that cover the cost of medical services in return for fees and costs.

Medical providers: A Medical provider is a medical professional or a facility that provides medical services.

There are two ways by which medical billing is done.

1: In House Billing

2: Outsource Billing

In House Vs Outsource billing

In House billing is when a physician or a Group uses the billing software in their own clinic/Hospital and entered demographics, Claims, insurance or other and submit and follow up is done by their own personals.

Outsource billing An outside organization prepares medical claims on the doctor’s behalf. Cash flow is much better when proper billing is preformed.

Revenue Cycle Management

      Patient Billing Patient AppointmentPatient RegistrationPatient Checkup – Diagnose/TreatmentDocuments Received through EMR/e-bridge
Appeal Procedure                                                       Revenue
Cycle                                           
  Management
  
Accounts ReceivableDemographic/Insurance Entry
Secondary Claims FilingEligibility Verification
Denial ManagementCharge Entry
Payment              ERA/EOBInsurance Acceptance file/Rejected ClaimClearing House Acceptance file/Rejected claimsElectronic Submission/Paper SubmissionClaim Submission

Health Insurances and Clearing houses

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

Some insurance Companies and carriers in US.

  1. Medicare
  2. Medicaid/Medical
  3. Blue Cross Blue Shield
  4. Aetna
  5. Cigna

Clearing House.

An electronic medical billing clearinghouse acts as a middleman that takes electronic medical claims information and then submits it electronically to insurance companies the medical billing clearinghouse contracts with.

How Do They Work?

Electronic claims are sent to the clearinghouse, which will check it for errors. If errors are detected, it is sent back to the medical provider for corrections. The clearinghouse updates the claim as it is processed.

Why Are They Important?

Without these clearinghouses, companies would have to submit claims directly, either electronically or in written form, and insurance companies would be overwhelmed by the amount of submitted.

What is the billing process?

  1. Patient visits the providers. New patient bill out medical history and registration forms prior to receiving medical notes.
  2. Provider gives her diagnosis and provides appropriate medical services.
  3. Provider sent in the information, relation to the patient’s visit to billing companies.
  4. Billing generates claims to be filed, manually or electronically, with insurance companies.
  5. Claim is follow up to maximize payment.
  6. Payment summaries are provided to providers.