Medical Billing for Beginners
Medical billing can be a complicated concept to understand. With the constant changes to Health Insurance, it is difficult to stay on top of the procedures. This article will help to simplify the medical billing process.
Let’s first discuss the definition of medical billing. Medical billing is the process of healthcare providers submitting medical claims to insurance companies in order to receive payment for services rendered. In better terms, medical billing is when your doctor requests payment from your insurance company for a service the doctor provided (i.e. exam, treatment, diagnosis, prescription, etc).
The process begins with a patient visiting a doctor or provider. At the completion of the visit, the doctor or a staff member updates the patient’s medical record to reflect the treatment or procedure received, the patient’s demographical information, and a diagnosis (if possible). The procedure and diagnosis are then used to develop a medical code. The code is dependent upon the level of the exam, the complexity of the diagnosis, and the patient’s medical history. Medical coding is completed by qualified personnel with experience in the medical coding field.
Once a code is determined, a medical biller will transmit the medical claim to the patient’s insurance company for review. The insurance company then evaluates the claim and decides on approval. If the claim is approved by the insurance company, the provider is reimbursed a pre-negotiated percentage of the billed services. If the claim is rejected, the insurance company sends it back to the provider to reconcile. When possible, the provider will make any necessary changes and resubmit to the insurance company. The reject and resubmit process can occur multiple times until the provider feels they have received the maximum payment the insurance company will reimburse.
As you can see, the medical billing management process becomes quite time consuming for a doctor or provider. The process of medical coding is very complicated. The wrong coding can cause a reject and resubmit to occur time and time again. Previous research on the topic shows that over 50% of medical claims get rejected or denied and these mainly transpire from a coding error.
To help prevent coding errors and to streamline the process, there are many medical billing companies that offer their services to doctors or providers. Cobalt Health is one example of a medical billing company. Cobalt Health takes care of submitting and processing claims, medical coding, and medical collections for their providers. A medical billing company, like Cobalt Health, has the software and technology to provide electronic billing as well. Electronic billing allows the medical billing company to do electronic insurance verifications before a provider conducts an exam. They also create a means for electronic claims submission to the insurance companies. The concept of a provider hiring a medical billing company to service their billing needs helps free up their time to focus more on their patients. It streamlines the process, secures their patients data, and reduces their number of unpaid claims. All of which lead to increased revenue.
Medical Billing is not simple but hopefully reading over this article you can begin to understand the importance of the process. The good news is that medical billing is becoming easier. The added electronic capability and existence of specialized medical billing companies, like Cobalt Health, lead us toward a less complicated outlook for the future.
Let’s first discuss the definition of medical billing. Medical billing is the process of healthcare providers submitting medical claims to insurance companies in order to receive payment for services rendered. In better terms, medical billing is when your doctor requests payment from your insurance company for a service the doctor provided (i.e. exam, treatment, diagnosis, prescription, etc).
The process begins with a patient visiting a doctor or provider. At the completion of the visit, the doctor or a staff member updates the patient’s medical record to reflect the treatment or procedure received, the patient’s demographical information, and a diagnosis (if possible). The procedure and diagnosis are then used to develop a medical code. The code is dependent upon the level of the exam, the complexity of the diagnosis, and the patient’s medical history. Medical coding is completed by qualified personnel with experience in the medical coding field.
Once a code is determined, a medical biller will transmit the medical claim to the patient’s insurance company for review. The insurance company then evaluates the claim and decides on approval. If the claim is approved by the insurance company, the provider is reimbursed a pre-negotiated percentage of the billed services. If the claim is rejected, the insurance company sends it back to the provider to reconcile. When possible, the provider will make any necessary changes and resubmit to the insurance company. The reject and resubmit process can occur multiple times until the provider feels they have received the maximum payment the insurance company will reimburse.
As you can see, the medical billing management process becomes quite time consuming for a doctor or provider. The process of medical coding is very complicated. The wrong coding can cause a reject and resubmit to occur time and time again. Previous research on the topic shows that over 50% of medical claims get rejected or denied and these mainly transpire from a coding error.
To help prevent coding errors and to streamline the process, there are many medical billing companies that offer their services to doctors or providers. Cobalt Health is one example of a medical billing company. Cobalt Health takes care of submitting and processing claims, medical coding, and medical collections for their providers. A medical billing company, like Cobalt Health, has the software and technology to provide electronic billing as well. Electronic billing allows the medical billing company to do electronic insurance verifications before a provider conducts an exam. They also create a means for electronic claims submission to the insurance companies. The concept of a provider hiring a medical billing company to service their billing needs helps free up their time to focus more on their patients. It streamlines the process, secures their patients data, and reduces their number of unpaid claims. All of which lead to increased revenue.
Medical Billing is not simple but hopefully reading over this article you can begin to understand the importance of the process. The good news is that medical billing is becoming easier. The added electronic capability and existence of specialized medical billing companies, like Cobalt Health, lead us toward a less complicated outlook for the future.
Labels: medical billing, medical billing company
posted by Cobalt Health at
1:24 PM
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