Those who don’t know about outsourced medical billing and coding will wonder how this works. If you are a medical practice and looking to outsource medical billing, then you don’t need to wonder anymore because we will give you most of the basic information you need on how medical billing companies work.
Medical billing and coding companies process and manage health insurance policies and claims. They help doctors and other health care providers collect payments from insurance companies and Medicare.
The medical billing process involves several steps: patient enrollment and registration, verification of insurance eligibility, demonstration and entry of charges, submission of claims, posting of payments, and AR analysis. Medical insurance consulting firms provide all these services to healthcare providers. Experienced medical billing companies can work on any type of billing software.
Here are the services that a medical billing company should provide along with the basic solutions.
Patient demographic and eligibility check
An error in the basic demographic information (i.e. age, date of birth, sex, address) of the patient can cause payment rejection. Medical billing companies have front desk staff to fill the required fields cautiously and always check the current insurance status of the patient, covered services, and perform pre-authorization.
Coding and billing automation
The world of healthcare and health insurance depends on skilled medical billing and coding specialists. Medical billing and coding specialists enable hospitals and clinics to correctly code procedures for collecting insurance claims and patient payments. Medical billing company’s basic job is to provide coding and billing services to healthcare services providers.
Medical billing is the process in which specialized codes are used to inform insurance companies why the doctor saw the patient and what they did. If the correct codes are used, the doctor is paid. Otherwise, the insurance company may deny the claim or not pay the doctor what he or she deserves.
Medical billing companies also offer medical transcription services. Medical transcription, on the other hand, is where a person writes what the doctor dictates in a patient’s medical record. The physician is responsible for describing the observations, diagnosis, treatment plan, and any procedures that have been performed. The medical transcriptionist is responsible for writing exactly what the doctor says in the patient’s chart, sometimes in a specific format that is legible and legal.
Both medical billing and medical transcription are necessary components in a medical environment and require specialized medical knowledge, keyboard skills, and the ability to use medical computer software.
Medical billing services involve submitting medical claims to insurance companies for reimbursement. Medical coders first translate the information in electronic medical records (doctor’s notes, laboratory, and radiological results) into appropriate codes that describe the services provided. The medical biller submits electronic claims for the physician’s services to designated health insurance companies.
A computer-assisted coding and billing system is one simple but most effective way to optimize revenues of medical practice. Medical billing companies manage coding and billing with electronic systems and ensure the accuracy of medical codes.
Update with the latest regulations
As medical coding and billing is the basic responsibility of a medical billing company. However, the medical billing service provider should also keep a medical practice updated with the latest regulations.
Medical billing companies should update with the most recent developments and health policy to ensure that your system is fully compliant with the latest developments. Verify with your billing vendor as well as clearinghouse/insurance companies regarding what changes are required to meet the latest requirements.
Healthcare is a rapidly changing sector where after every few months new regulations can impact the working of a provider. This is why it is imperative to stay updated on the latest laws and regulations implemented by the healthcare regulators.
It is much easier for a medical billing company to stay updated with the latest updates and they must inform to provide the new regulatory changes.
Reports and audits
Medical billing company must review the system every 90 days and assess the ratio of bills being rejected. The rejections should be analyzed to find a cause.
A plan should be devised to avoid rejections in the future such as a denial management strategy. The claims should be followed up on and resubmitted after fixing. Look for the areas to improve and create a strategy.
A medical billing company must update its client with periodic reports and analysis of returns and account receivables. These reports provide a quick view to providers that they are on the right path and are successfully collecting the payments. Through these reports and audits, providers take the view of the overall performance.
Update on collections and follow-up
On successful remittances, providers are notified with full transaction history. If any remaining payments which are not covered by insurance, the billing services provider can inform the patient and request payments.
Sometimes insurance carriers delay the payments with minor objections. After a certain time, the billing company needs to inquire with the insurer about status, remove their objections and resubmit the bills, and if need be, submit an appeal for nonpayment or underpayment.
These are just some of the additional support that a medical billing services provider must offer to medical practices.