The basics of Medical Billing

 Medical billers are responsible for the timely submission of technical or professional medical claims to insurance companies, including doctor's offices,  hospitals  , nursing homes, or other health care facilities. In a  hospital setting  , medical billers perform different functions than medical billers working in other settings.

Understanding the basics of health insurance plans enables the medical office staff to effectively communicate with patients regarding their health insurance benefits and discuss the details of patient accounts with representatives of the insurance companies.

Medical billing services

The medical billing process

Patient Registration -  During the patient registration process, patient demographic information is entered, including insurance payer, policy number, and other information necessary to process a clean claim.

 Insurance Eligibility and Verification -  Because insurance  information can change at any time, even for normal patients, it is important for the provider to verify the member's eligibility each time services are rendered. This step in the process is also required to obtain benefit and authorization information.

Charge Entry: Charge  Entry is the entry of charges for services received by the patient and includes the proper linking of medical codes to services and procedures provided during the patient's visit.

Coding of diagnosis, procedures and modifiers  : Coding of claims allows the insurance payer to know the patient's illness or injury and the method of treatment.

Claims Submission  : Once the claim is completed, the third party is sent for payment to the insurance payer. In order to efficiently file medical claims, medical billers must know or have access to a lot of information for each insurance company.

Payment posting -  Payment posting involves posting and posting functions and reconciling posting activities with deposits.4

Paper billing is not the first option for billing medical claims, but it is sometimes a necessary task. Of course, the electronic claims process is much simpler and faster compared to the manual paper billing process.

Most of the   larger insurance payers offer electronic claim filing. You can choose between direct billing or set up an account with a clearing house.

A clearinghouse is a company that will accept all of your claims and electronically forward them to insurance payers for processing. They also have edits in place to check for errors on your claim to help avoid billing delays.

The main benefit of electronic invoicing, whether you use clearinghouse or direct invoice, is that it will speed up the processing of your claims. Paper billing can take up to 45 days to process

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