Medical billing is a necessary step in the large and often complex system of healthcare information and payment. What begins with a visit to the doctor kicks off a long, behind the scenes process of submitting and following up on claims with health insurance providers to ensure payment is received for services rendered. As a result, many facilities seek professional medical billing service companies to manage their claims. The best medical billing companies can strategically optimize revenue performance for the practice.
Understanding the importance of the medical biller’s job requires knowledge of the entire cycle. Although the initial visit or check-up may be a simple one-to-one interaction, it is actually the first step of a three-party system between the patient, healthcare provider (hospitals, physicians, therapists, nursing homes, etc.), and insurance company. After the visit, medical billing management services must negotiate and arrange payment between the parties, billing both the patient and insurance company to ensure the healthcare provider is compensated for any services rendered.
While this process sounds straightforward, there is a ton of work done behind the scenes before it can be considered complete. First, the medical billing service must collect all of the information related to the patient and his or her procedure to create a claim (a bill for the insurance company). Some of the required information includes eligibility and benefits verification for treatments, hospitalizations, and procedures.
After submitting the claim, the biller must follow up to ensure the payment is received. This involves checking each insurance payment for accuracy and compliance with the original contract, calling insurance companies if there are discrepancies in payments, and appealing any denied claims. This process is critical for the financial cycle of healthcare providers of all sizes, from large medical centers to medium-sized facilities to single-provider practices. However, given the complexity medical billing services for small practices is commonplace.
Medical billing requires a great attention to detail as there is a ton of sensitive information (patient demographics, procedure details, provider information, etc.) passing between parties. As a result, most medical billers have experience with the electronic and paper systems used in online medical billing services.