Medical billing is a process by which claims are submitted to insurance companies to ensure that a doctor is compensated for his services to a patient. A person implicated in medical billing should possess knowledge of medical terminology, claims processing procedures, HIPAA regulations, diagnostic terminology, insurance forms, insurance specifications, collections and related details. The medical billing process consists of insurance verifications, authorization, coding, billing, follow-up, re-submissions, patient billing and so on. The software used for medical billing includes EMR (Electronic Medical Records), EPM (Electronic Practice Management) Lytec, Medic, Medisoft, Misys Tiger and United among others.
Medical coding (insurance coding) is a process by which the diagnoses of diseases and medical procedures are converted into defined codes. The coding is classified as ICD coding, CPT (Current Procedural Terminology) and HCPCS (HCFA Common Procedure Coding System) coding; codes comprised of numeric or alphanumeric designations. Medical coding ensures that the doctor or health service provider gets compensation from insurance agencies or consulting firms for his services. Through medical coding, the insurance provider will get an idea of the entire medical history of the patient, the health services received by him and also the medical insurance claims. There are two types of coding problems-under coding and over coding. Under-coding leads to loss in revenues, and over coding results in denials and reviews. Outsourcing of medical billing and coding is becoming increasingly common in the present scenario.
Claim Generation and Submission Claim generation includes entry of patient demographic, insurance and encounter information into medical billing software. Claim submission is the process of sending that data to the carrier, either electronically through a clearinghouse, or via paper submission in the mail. With electronic medical billing, services should apply one or more “scrubbers” to the claims (and manual quality checks to paper claims). Scrubbers are quality assurance checks of diagnosis and procedural codes for errors or mismatches typically integrated into premium medical billing software programs.
Carrier Follow Up Carrier follow-up is an integral part of the medical billing industry- arguably the most important aspect. The quality of a medical billing service is often defined by the level of follow up they apply to claims and will have an enormous effect on reimbursements. Through follow up, medical billing companies are able to isolate those claims that may go unpaid, or partially paid, and work with the provider and carrier to make sure edits and resubmission (if necessary) are clean.
Secondary, Tertiary and Workers’ Comp Claims These special claims usually require special consideration and handling as they often entail additional documentation. Service providers can sometimes get bogged down in the details required for these unique claims if not experienced and prepared.
Practice Reporting and Analysis Reports can be generated through almost any medical billing software, but how often and with what depth will your medical billing service provide these reports? Reports provide critical information about avenues for practice improvement such as directions for growth, cost savings and ways to increase profitability. The importance of reporting cannot be overstated for monitoring the health of the practice. Reports should be provided at least monthly, and experienced medical billing service providers should be able to make recommendations on how the practice can enhance profitability.
Patient Invoicing and Support Patient invoicing is a very detail-oriented process, but if done properly it can significantly enhance practice revenue. Nonetheless, balancing accounts, printing statements, stuffing envelops and applying postage can be very time consuming. And once patient statements are sent, someone will inevitably have a question about their bill. A good medical billing company has the infrastructure to support patient inquiries with customer oriented approach showing they understand their conduct is a reflection of your practice.