Understanding Medical Billing Services

By Author: Abigail F
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Medical billing services includes the process of submitting and following up on claims with insurance companies in order to receive payment for services rendered by a healthcare provider.

Medical billing services includes the process of submitting and following up on claims with insurance companies in order to receive payment for services rendered by a healthcare provider.

Whenever a patient attempts to use health benefits covered by his or her insurance provider, the hospital or the doctor will contact the insurance company and submit claims for the bill. The insurance company then verifies the claim and after completing all the necessary paperwork, pays the bill. This whole process is called the billing cycle. The billing cycle can take several days or weeks to complete depending upon the nature and amount of the claim made by the healthcare provider.

The billing cycle begins when the personal medical file of a patient is updated. The file contains information such as the name of the patient, age, and the nature of the illness the patient has been treated for. A representative of the insurance company ...
... then investigates and verifies the claim. He or she looks into things like a patient’s medical history, the decision-making process, the complexity of the illness, demographics of the patient, and the quality of the service provided in order to determine the actual billing cost.

After all the investigation and verification is complete, if everything goes right, the bill is officially submitted and accepted by the parties. If there is a problem in the claim, the patient, hospital, and the medical billing service provider are notified by the insurance company and asked to re-file the claim.

Medical billing service providers do all the required paperwork that follows. A medical billing service attempts to lessen the workload and reduce the burden on both the patient and the healthcare provider. The rules and regulations of the insurance companies and the health laws are often complicated and confusing for people to understand. This sometimes leads to the manipulation of the laws by the insurance companies in order to maximize their profits at the expense of a patient. A medical billing service hires professionals whose sole purpose is to protect the interest of their clients and to provide a quick, clean and rapid billing cycle. This billing method is also known as outsourced medical billing.

Outsourced medical billing is rapidly becoming popular in today’s time. And that is simply because of a few logical reasons. First of all, outsourced medical billing ensures that a healthcare does not hire and support any extra clerical staff. This directly results in reducing the operational cost. Secondly, as previously mentioned, the rules and regulations regarding medical insurance are often quite complex and confusing to understand for most people. Outsourced medical billing ensures that your case is being filed by professionals who know what they are doing and can better protect your interest in this regard.

Summary:

Medical billing service is an intermediary between the claimer (the healthcare provider/patient) and the payer (the insurance company). The main purpose of a medical billing service is to provide assistance and professional help to the claimer throughout the billing cycle. A billing cycle refers to the process of filing a claim and then eventually winning it. This includes updating the patient’s personal file with the information such as his or her name, age, nature of illness, diagnosis and the quality of the service provided to that particular patient. The file is then submitted to the payer or the insurance company which then investigates and verifies the claims made by the healthcare provider. Upon their satisfaction, the bill is then settled. The concept of outsourced medical billing is currently growing rapidly. This means that a third party is put in charge of the filing and settling of the claims by the healthcare provider and the patient. This is done due to several reasons such as reducing the operational cost by not having to hire clerical and technical staff, protecting the patient and the healthcare provider from the manipulations that are often practiced by the insurance companies, and to have the satisfaction of hiring a professional to do the job.
Resource: http://intelli-bill.com/