A Brief about the Billing Process under Medical Billing Services

Medical services are indisputably complex services to offer and demands around the clock alertness and snugness, because one dime’s mistake is capable enough of resulting in million dollars’ havoc. Prior to the advent of medical billing services, the staff of medical institute always complained about being overburdened with medical duties as well as administrative duties. Although medical assistants is a productive solution, but when it is about big medical institute like hospitals where number of visitors as patients are in millions, a bunch of medical assistants neither can be easily hired nor they can handle heaps of paper formalities especially insurance claims. This is where; a medical institute looks for a company to whom they can outsource all these worried pertaining to health insurance claims. In this article we will be discussing the billing process.

Billing process
So far we know that, medical billing and coding services are related to submitting, processing and following up insurance claims to the concerned companies. Now let us understand its billing cycle:

Visiting a medical institute: The process can also be termed as a deal between the medical institute or doctor and insurance company. The process starts when a patient visits a clinic for his medical ailment and the medical staff, for the first time creates his medical report containing specific information about his medical history and personals.

Medical Report consists: This medical report contains all relevant information about patient such as his name, his social security number, contact details, his pre and post medical history and the test performed or to be performed.

Coding: After a basic medical report is prepared, the patient undergoes through various medical tests and level of service for billing services is determined on the basis of their results, complexity of the medical decisions to be considered and the pre-treatment medical history. Once the level is arrived, medical staff allocates a code (five digit standardized code) and the talked code is extracted from CPT’s database (Current Procedural Terminology). In addition to CPT code, there is another code known as ICD-10-CM, acronym “International statistical classification of disease and related health problems”, is also required and equally important as well. Without this code, the billing cycle won’t complete and one may have to face notifications like Pending claims, Denied Claims, Rejected Claims or Missing Claims

Sent to insurance company: After a code is arrived and the bill is prepared, it is then forwarded to the insurance payer (the payee insurance company). The insurance company, then use the expertise of its claim examiners and insurance adjuster for arriving at a decision about claim. If everything goes well, bills are approved or otherwise in case of any discrepancy found, the lodger is intimated about that.

The entire process is time consuming and it may take anything from few days to few months (depends on the level of complexity within claims), till a medical billing services company actually comes up with a bingo.