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Medical Billing Service: The process of Revenue Cycle Management

The process of Medical Billing is a form of communication between an insurance company and […]

The process of Medical Billing is a form of communication between an insurance company and a care provider. The Billing Cycle or the Revenue Cycle Management is the term used to elaborate and explain the entire Medical Billing Service phenomenon.

The process of Medical Billing Service can take a moderate to a large amount of time, depending on the effectiveness of interaction between the provider and the insurance company. The care provider and the insurance company have a relationship based on contract where the providers are in a contract with the insurance company for rendering healthcare services to patients.

The process of a billing cycle begins when a patient visits his provider. The administration or the provider himself will then update the patients Electronic Medical Record, which includes the patients demographic and medical information such as address, phone number, family medical history and current medicines being taken etc. This information is then used to check and determine the extent of services that the provider will be able to render for the patient and the bill sent out to the insurance company.  After that, the practice will determine the have the level of service translated into a code taken from the CPT and ICD-10 so that it is easier for all parties involved to review the details on the electronic medical records system.

Once this is done, the medical billing staff will develop a claim for the patient based on their information and share it with the insurance company through Electronic Data Interchange or a third-party if the practice uses one. Upon receiving the claim, the insurance company will review the claim, determine and verify its validity and eligibility. If the claim is approved, then these are usually reimbursed according to pre-agreed terms between the provider and the insurer. If the claim is denied, then the insurance company sends a notification to the provider letting them know of the rejection so that they can process it and inform their patient. Even after a rejection, patients have the option of filing for an appeal with proof and relevant documentation which can, in many cases, change the original decision.

 


Frank Quinn

The writer is a leading Health IT analyst contributing regularly on some of the most pressing topics like Electronic Health Records, Practice Management, eRx, Patient Portal, Billing Services, Compliance and Privacy and Security.

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