Healthcare facilities must balance providing comprehensive patient care with completing necessary administrative tasks to maintain business revenue. Medical billing and coding can be time-consuming. You can outsource medical billing services to experienced companies to increase accountability, accuracy, and timely reimbursements from insurance claims.
Here’s an overview of how billing services work with insurance:
What Is a Medical Billing Service?
Patients visiting your healthcare facility can pay for the service using cash or medical insurance. A medical billing service helps you process, submit, and follow up on payments and insurance claims. You can use an in-house team, but the costs are higher compared to leveraging independent billing services. Outsourcing the billing service will save your staff time and effort, allowing you to focus on providing healthcare.
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Medical billing companies have trained personnel who are knowledgeable about how insurance companies work. The company will file the insurance claims and follow up on rejected claims. Medical billing companies also help contact patients to clear all unpaid bills that may be in their accounts. To keep things running smoothly, the billers work with insurance companies, healthcare facilities, and patients. The goal is to help healthcare facilities receive timely payments.
Medical Billing vs. Medical Coding
Although medical billing and coding are two different services, they’re often mentioned together. Medical coding involves assigning standard codes to individual services offered by a healthcare facility. Coding is required when preparing claims submissions and helps insurance companies determine the services rendered and amounts due. Billing is the umbrella service that covers coding, processing, claims requests, and follow-ups.
Leading medical billing companies also offer coding services. Healthcare facilities can also complete in-house coding. You can leave the coding to certified experts if you’re already working with a medical billing company. Once the codes are assigned, the biller can process patient payments and submit reimbursement claims to the relevant insurance companies. The billing companies are experts in submitting the proper paperwork to insurance providers.
How Billing Works With Insurance
A medical billing service makes sure the doctor’s office or healthcare facility receives payment for the service rendered. Healthcare services follow a set of standards provided by the HIPAA TCS (Transactions and Code Set Rule). The prices aren’t set in stone, so most insurance providers negotiate for lower prices. Patients also purchase unique insurance policies, meaning the benefits may be lower in some plans.
When one receives treatment, the medical biller will process the due amount and determine whether the patient will pay cash. If the patient’s bill is covered by insurance, the medical biller will use the standard codes to file the appropriate paperwork. The paperwork is then sent to the insurance carrier to claim reimbursement for the provided service. Insurance companies will then review the claim and determine whether they’re willing/able to pay the full amount.
In most cases, medical insurance companies will negotiate a lower price. Once an agreement is reached, the insurance provider will clear the amount and send the patient an EOB (Explanation of Benefits). An EOB is a document explaining the procedures and treatment received and paid for by the insurance.
For medical billers, the challenge is to file successful claims for standard treatments. Leading medical billing companies implement sophisticated software tools to capture details from when the patient arrives at the hospital. The billers can then code medical bills and send them early to the insurance company to claim reimbursement. Claiming payments involves a lot of paperwork and negotiations with the insurance company.
Outsourcing Your Medical Billing Service
Independent practice doctors and healthcare facilities need efficient billing services and practices. Outsourcing the service to experienced companies can take the responsibility off your hands without compromising accountability. Medical billers have the expertise and knowledge to work with healthcare providers, patients, and insurance companies. They can help your company collect payments and insurance reimbursements on time.Stick to reputable companies with a clean track record and efficient revenue cycle management. You should customize your medical billing service to the business and its clients. Work with experienced companies that can guarantee transparent terms, intelligent technology, and sophisticated software systems. The goal is to improve clinical, financial, and operational outcomes by making sure that bills are recorded accurately and cleared on time.