Today, many developed nations such as U.S, U.K, and other European nations outsource their operations to the developing nations. So, such nations outsource many types of operations such as medical transcription, legal transcription, inbound and outbound calls, financial analysis, accounts, etc. So, medical billing is one of the operations that are outsourced from some of the developed nations. In the course of medical billing, three parties are involved namely the insurance companies, hospitals and patients.
What is medical billing?
The patients who are undergoing treatment contact the insurance companies addressing about their illness. These insurance companies then pay the claims to the hospitals. The hospitals who are providing treatment, directly forward the expenses to the insurance companies. The insurance companies then make the payments to the hospitals directly. The medical billing professionals maintain the records of the patient’s history, medical report and medical expenses. They are also knowledgeable about claiming taxes and providing exemptions. So, these professionals provide valuable services to the hospitals. The hospitals require some experts who can handle multiple tasks such as accounting, billing, handling claims, rejections, tax issues, billing medical insurance claims
etc. So, they drastically save the costs of the hospitals, otherwise the hospitals should separately appoint staff members who charge higher salaries. They also attend to the queries of the customers.
What services do medical billing parties do?
The services that they provide are medical coding, billing, electronic health records, physical insurance authorization and medical billing etc.
Following are the services provided by medical billing professionals:
They book appointments for the patients. They also verify if the appointments of the patients are actually billed.
Along with their medical report, they also verify the patient’s insurance eligibility
They enter the details of the patients and calculate their claim charges
They negotiate the amount with the hospitals claiming for tax dedication or concessions. They are knowledgeable about the concessions and tariffs provided by the government.
They ensure the CPT code of the patient and the ICD diagnosis code of the patient. They both should correspond the AMA approved codes.
The procedure codes that are supplied should not be the part of CCI edit.
The referrals and authorizations of the managed care should be present on the file.
They should batch and transmit the claims first to the clearing house.
Then, the amount may not be sanctioned by the insurance company. So, the medical billing professional should negotiate with the insurance company to compensate additional amount to the patient.
If the claims are paid inaccurately, then the medical billing professional should address it to the insurance company and take corrective actions.
They should also submit the tertiary and secondary claim submission if applicable for a patient.
The professional also should update the industry standards, local regulations and Medicare claims.
They maintain weekly and monthly record of the patients. The patient’s should approach them for any queries and they should maintain every detail about the patient and should know the date of appointment, the reason of appointment and the surgeries or treatment that they are undergoing. Their duty is not only restricted to invoicing, but also building interpersonal relationship with the patients.