Role of Medical Insurance Billing Companies for Physicians

In the process of medical settlement, three parties are involved namely the hospitals, insurance companies, and the patients. The hospitals provide medical services to the patients and claim a certain amount for providing medical services to them. The insurance companies forward the amount to the hospitals to settle the claims of the patients.

Accountants and medical billing services

The accountants or medical billers prepare invoices, patient’s records, etc and forward it to the insurance companies. The insurance companies then make the settlement. The medical billers verify if the accurate amount is paid by the insurance companies. When the insurance companies, deny paying the entire amount to the hospitals, then the medical billers handle the denials. They negotiate with the hospitals and help the patients in settling the amount.

The tasks of medical billing professionals

Medical insurance billing companies provide services to physicians. After preparing a patient’s history, diagnosing and recommend for treatment, then the physicians claim some amount from the patients. Then the medical billers prepare invoices stating the total amount that is payable by the patients. So, they perform many other tasks in this process such as.

  • The process of billing is complex and the accountants should handle many other issues in this process.
  • They should comply with governmental rules and regulations, legal formalities and also update technological changes. So, they should manage the financial aspects and save money and resources.
  • They should verify the patient’s records, insurance eligibility, and benefits.
  • They should enter the demographics of the patients and assign them a code.
  • They should also maintain the record of claim settlement and also the health insurance billing procedures.
  • After assigning the CPT and ICD codes to the patient, they should check if they correspond with the AMA approved codes.
  • The procedure codes are provided by the medical billers and they should not be the part of CCI edit.
  • Every file that is maintained should be authorized and the name of referrals should be mentioned on the file.
  • The claims should be forwarded to the clearinghouse.
  • The insurance claims should be forwarded to the insurance companies
  • They should handle the denials if the insurance company has not paid the entire amount.
  • The tertiary and secondary claims should be submitted if necessary

The medical billers always prepare weekly and monthly record to analyze the data of the patients. They should always update the industrial standards, technological changes in the market, etc. the changes should be made into the respective software. The versions of the software constantly change and hence the medical billers should always update the versions so that they are able to enter the transactions as per the recent accounting standards. They should always be aware of governmental rules and regulations. The tax rates, tariffs, are constantly changing and they should update with the changes.

Related: Ask Your Pharmacist: A Synopsis of the Pharmacist’s Role as your Local Health Caretaker

They also provide billing solution to the hospitals so that they can save their costs. They provide a complete revenue cycle management, provide CPT and ICD coding, and provide the pre-certification management. They interact with the clients to access their clean filing, recovery of unpaid claims and provide more meaningful reports.  

Related: 3M to buy M*Modal Healthcare software firm for $1 billion

1 Comment
  1. Medical insurance is very important for all the persons working in different fields.. Very informative article!!

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