Medical billing services are important in the US health care system. They help convert health care services to accurate insurance claims and patient invoices. Billing staffs ensure hospitals, clinics, and private practices get payment in a timely manner. The specialists know how to read codes for diagnoses and procedures and learn from the insurance carrier if authorization is needed. Billing must be accurate and compliant with government regulations while protecting patient-identifying data, and free from any billing errors and fraud.

What is Medical Billing for Providers?

Medical billing refers to the process of specifically defining and billing healthcare services. This entails submitting a bill and following up on the initial claim until the provider is paid. A billing professional works to ensure that practices gain proper reimbursement.

Is Medical Billing a Necessary Part of Health Care?

Managing billing is becoming an increasingly complicated function. Frequently doing good patient care may become secondary to a focus on billing adequately to improve reimbursement. Leveraging third-party billing specialists with billing knowledge and skill set can help improve revenue with a better return on investment (ROI).

Key Functions of a Medical Billing Company

Data Management

Data management refers to the collection and protection of patient and billing data during the revenue cycle. Managing the data effectively as it goes through the billing department will help to ensure compliance with HIPAA and speed up the process of getting reimbursed.

Insurance Verification

Prior to the delivery of services, the billing service organization confirms the patient's insurance coverage. They determine if the policy is active and validate the co-pays. Additionally, the billing team checks deductible amounts, and whether pre-authorization is needed. This helps the patient avoid unforeseen costs and helps reduce fraudulent claims denials.

Medical Coding

After the patient visit, the services provided and diagnoses are assigned a standard code. Diagnoses are coded using ICD-10 codes, while procedures and supplies coded are identified with CPT and HCPCS codes. The coding process goes through a review and verification, with modifiers applied as necessary. Correct coding is necessary for billing, compliance, and communication with the insurer.

Pre-Authorization

Certain treatments need to be approved by the insurer before the treatment begins. Prior authorization is a process to ensure the treatment is medically necessary and minimizes denied claims or the patient receiving a surprise bill.

Claims Submission

Billing services submit claims to the insurer when they are confident the claim is clean and accurate. They also include any supporting documents the insurer has requested. Billing is done timely which minimizes claim delays, claim rejections, and loss of revenue.

Dealing with Denials

Claim denials are reviewed to determine the reason for the denial. The billing team can correct the claim, or appeal the claim to recover the lost revenue. Denial rates can be reduced when a billing team is involved in the process.

Accounts Receivable (A/R)

A/R signifies the outstanding balances payable by the patient and the insurance company. Efficiently running A/R maximizes timely reimbursement and reduces bad debt. This results in steady cash-flow.

Patient Invoicing and Collections

After payment by the insurance company, billing services will invoice the patient for the outstanding balance. The billing team prepares clear patient statements, give payment plan options to the patient if necessary and work to recover the remaining balance if the bill goes unpaid.

How Medical Billing Solutions Improve Revenue Cycle Management?

Numerous healthcare providers experience difficulty in hiring skilled billers and coders and recruiting a team of experts can be a time-consuming process. Professional coders ensure claims are correct with no errors. Correct coding increases the chance of full reimbursement. Medical codes are important in communication. They describe a patient’s diagnosis, the medical necessity of a treatment, services provided, and other conditions that may affect care. These codes provide insurers with specific information to grant efficient claims processing.

Benefits of Outsourcing Medical Billing Services

Professional billers review each claim and its coding in detail. This process reduces errors, leads to faster reimbursement time and ultimately increases the overall efficiency of billing operations.

Experienced billing teams follow the constant changing regulations governing healthcare ranging from the No Surprises Act and other regulations that help to avoid costly fines and compliance issues for the provider and practice.

The timely submission of accurate claims leads to faster reimbursement time. Outsourced billers reconvene denied or rejected claims also in a timely manner to avoid delay and revenue decrease.

By outsourcing, providers do not have to hire, train, or keep on payroll in-house billing professionals\ or pay for expensive billing software. This would allow the provider to spend its resources treating patients rather than administration.

Billing costs can be reduced through outsourcing by up to 80% with hourly rates starting as low as $7 per hour. It gives the ability to manage the revenue cycle. It should save time, reduce stress, and focus on patient service.