Medical coding is a numeric prescription evaluation by a doctor to obtain a drug. The code translates the prescription into alphanumeric codes such that a different code is available for each injury and diagnosis.
What is Medical Billing?
The medical biller’s job begins as the medical coder’s employment ends as Medical billing & medical coding are interconnected areas in health care. Both involve the essential procedures of claims so that healthcare providers get their insurance claims as soon as possible.
After the report is coded, it goes to the medical biller.
To some extent, medical billing is more straightforward, as it seems, since medical billers receive the data from medical coders and prepare bill(s) for the payer. These bills go through the formal judgment before they reach the biller, then they prepare to fill on behalf of patients. So now we understand that the medical billing method is complex.
Additionally, some patients have co-payments or some other arrangement with the insurance company; thus the biller collects all the documents, verifies them, and then generates a proper bill to send to the patient.
If a bronchitis-afflicted patient has an insurance plan covering this visit and treatment, their account will be relatively low. The patient may have a copay or have another arrangement with their insurance company. The biller considers all of this and creates an accurate bill, which is then passed on to the patient.
If the patient refuses or is unwilling to pay the bill, then the medical biller’s responsibility is to arrange a third agent to make payments to the healthcare provider; it indicates that the medical biller liaison & simplifies the triangulation of the patient, healthcare provider, and an insurance company.
Biller is a translator; since the coder’s job is transcribing medical processes into code, the biller prepares financials based on those codes. Thus the medical biller’s responsibility is to support the operation of reimbursement.
An Example For Instance:
Let’s repeat the example to understand medical billing. A patient has a cough and is facing lots of mucus; therefore, medical billing starts when the patient goes on an appointment with the doctor.
The medical biller receives the codes, showing the purpose of the visit; moreover, it shows the symptoms in the patients, along with the doctor’s diagnosis and prescription, further preparing an insurance claim on this data in specific software.
Formal Claims Preparations:
The typical jobs of medical billers include a variety of tasks, one of which is formally preparing claims and ensuring the accuracy of financial reports, thus initiating billing for the patients. In this respect medical biller obtains all the codes from the medical coder, either in the form or through some computer language, then prepares a detailed medical claim, moreover to make it clear again that the claim is a patterned list of all the processes, services, and cost from health care provider to the insurance company to ensure reimbursement for the healthcare provider.
Familiarity with the Insurance Policy:
This is a simple process, but it can be complicated. The medical biller should match all the corresponding codes to avoid this complexity since it is a quality assurance process after completing the coder’s report. Here, medical billers should be familiar with all the terminologies of medical billing and present forms of CPT, ICD & HCPCS codes.
Medical billers should be familiar with the patient’s insurance policy to determine the patient’s plan and if it is covered by the services provided by the health care provider.
Medical billers should ensure that all the procedures and codes are billable because all insurance companies have set rules to follow; therefore, billers need to be familiar with all the rules and policies.
Medical facilities have different charges for each procedure, so through the billing process, a biller must remember that all the claims conform to these specific rates to prepare medical claims to send to the payer. Depending on which payer the medical biller is sending the claim to, the claim may go through the clearing house or straight to the payer.
To outsource medical billing services, you should know the medical billing companies’ services and the medical biller’s above qualities to ensure the quality of the whole procedure from coding, billing and to claims. After you are done with a contract with the medical billing company, you should be confirmed about timely claim submissions, patient follow-ups, or coordination with the insurance companies. There are some services offered by medical billing companies as follows.
Bills and Claims Submission:
One of the essential benefits of the medical company is billing and claims submission; after connecting the EMR (Electronic medical records), medical billing companies retrieve all the data of the patients, including the details of the visits, biodata, and the concerned information to fill in the claim forms, followed by the claims scrubbing tools for every single claim that should go to the payer to confirm the fulfillment and accuracy of the information including applicable codes to ensure quick & complete settlement.
Additionally, if some claims face denial, the medical billing service company handles the follow-up and resubmissions of the case while maximizing the revenues for the health care provider.
Benefits Recovery and Verification:
It is frustrating to find out that a service you provided is yet to be covered by the specific benefits, resulting in the denials of claims and overcharged accounts. A medical billing company will help your team by asking the right questions to determine whether a patient’s insurance plan will cover specific services before you render them.
Credentialing:
Suppose you need to contract with a new insurance company. In that case, the medical billing company helps prepare all the required credentials, thus facilitating coordination with government payers, including Medicare, Medicaid, and VA insurance. The medical billing company trains your staff on advance updates to avoid missing any documents for reimbursement.
Reviews:
Along with verifying the patient’s benefits, the medical billing company requires formal authorization from the insurance company to perform certain services for specific codes. Since all the functions of the insurance companies are complex to understand, a medical billing company serves as an advocate on your behalf to meet the insurer’s needs to ensure timely payment of claims.
Payment Collection & Accounts Receivables:
Staff at health care may be busy with the people who still owe against the services rendered in the past, here the role of the medical billing company is to release your team from this additional burden so the medical billing company reaches people by phone, e-mail, and mail to recover the debts expected as bad debts. This extra task from the medical billing company increases the revenues and the quality of work.
Transparent Reporting:
Medical billing companies ensure your access to advanced financial information systems regarding all the services offered. Billing companies accomplish claim submission & rate of acceptance while making sure about the transaction entries.
Time-Saving Along With Revenue Generation:
When you outsource all the time-consuming tasks to a responsible professional billing company, it saves you time. You can make good returns on your services with prompt and efficient service delivery well in time because billing companies manage your revenue cycle management.
Healthcare Revenue and Revenue Cycle management:
As mentioned above, regarding the importance of revenue cycle management, let’s look into the structure of revenue cycle management to facilitate you. Medical billing is a systematic process for services & generates revenue eventually- it elaborates the procedure from the first appointment through the payer’s acceptance of the final bill payment.
After going through the detailed discussion, one should know some of the features of a preferred billing company.
- ISO & ISMS certification.
- GDPR compliance.
- 100% HIPAA, HL7, CPT, HCPCS, & ICD-10 compliance.
Following the above international standards and requirements of the best medical billing companies, the list of the top 10 medical billing companies is as follows.
Top 5 medical billing companies in the US
- Billing Freedom
- Billing Paradise.
- AdvanceMD.
- Kareo.
- Revele.
After an elaborate article, you should select medical billing with clear selection criteria to facilitate all your billing needs. Moreover, a stress-free working environment allows proper patient attention and revenue generation.
Written by: Antonio Skits
About the author: Antonio Skits, a learned resource person in the field of Medical billing, wrote the present article. He is an expert and guides people about common mistakes so that people avoid hurdles in insurance claims.
