Medical Billing, also known as Revenue cycle management, is considered to be one of the most essential parts of any practice. It helps physicians get paid for the services they have rendered. Depending on various factors, like the practice size, the routine and schedule of the provider etc, physicians can either opt for an in-house billing team or simply outsource it to a third party. Both methods have their pros and cons, however, in this blog I would particularly talk about what medical billing is.
The process starts when the patient calls the practice for an appointment and the practice manager or the provider himself takes down the demographics and, of course, the name of his insurance company.
After the provider has completed the clinical procedure, every procedure undertaken is given a standardized, alphanumeric, billing code. Upon completion, the medical billing department sends the bill to the insurance company of the patient. Today, with information technology persistently backing the healthcare industry, the bills are communicated electronically. Such bills are called “super bills”. This is where one part of the process is completed.
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Once the claims are received by the insurance company, it then reviews the insurance details. The company evaluates if the insurance covers the patient at the time of service or not. It also calculates the amount of eligible monetary claims that the individual can make. In order to ensure transparency, it also confirms whether the procedure/treatment undertaken is apt for the diagnosis. After comprehensively scrutinizing all the details, the company finally decides either to approve or reject the claim.
If the claim is approved, the amount is electronically transferred to the provider. But, in case of rejection, the provider is informed about the reasons behind the denial. Furthermore, in either of the situations, the patient is provided with all the necessary details directly by the insurance company.
Of course, physicians want to get paid for their services in a timely manner. Nevertheless, it is also important to understand that the time required for revenue collection from medical billing is directly proportional to the efficiency of the billing team or service as well. The more efficient the billing service, the faster the physicians get paid and vice versa. Now, this is where the conflict between in-house and outsourced medical billing service begins, however, I would prefer leaving the debate unattended in this write-up.
Read more: 5 Questions To Ask a Medical Billing Service
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