Physicians and Doctors are some of the busiest people around. Their duties include seeing patients, keeping an eye on the latest medical breakthroughs and new treatments, writing up charts while trying to manage their practice. The best doctors are looking to stay ahead in their field and be at the front of the latest developments of medical research and technology. This helps them offer the best of services and care for their patients.
Medical billing, what exactly is medical billing and just how does it work?
Medical billing is the communication path between both the medical provider and the insurance company. It’s more commonly referred to and known as the billing cycle, it can be a lengthy process and the billing cycle can take days and even months to complete, it not uncommon for at least several communications to take place before a resolution is achieved.
The process is started after the medical care provider patient visit. After completion of the updating of the medical record of the patient, a clearer picture of diagnosis and treatment required can be seen. All these details are then stored and recorded electronically for future account updates.
An accurate evaluation of care is determined and a five digit code is assigned from the database. What the doctor has verbally diagnosed is also translated on record as a separate numerical code. Both of the created codes are then used in claims concerning the billing process.
These codes are then transmitted to the insurance companies that are involved. It is commonly done electronically via an ANSI 837 file.
Medical claims adjusters or examiners usually process claims, but when higher amounts are involved sometimes a medical director will evaluate the validity of the claim. Once the claim is approved the medical provider is reimbursed based on a pre-negotiated percentage. Any rejected claims are sent back in the form of Explanation of Benefits or Electronic Remittance Advice.