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Medical Billing and Insurance Claims

Medical Billing and Insurance Claims

Medical billing services can help in dealing with insurance claims related to your healthcare expenses. This article provides information on both these topics and associated details.
HealthHearty Staff
The term medical billing refers to the process of submitting claims to the insurance companies, and following them in order to collect payment for the services delivered by a healthcare provider. One can start these services to provide billing and collection to the providers. Many of the suppliers depend on such dealings for processing claims to insurance companies (payer), instead of claiming themselves.
For example, a patient visits a healthcare physician for treatment or a medical checkup. He gives his personal details (age, sex, location, etc.), and also talks about the insurance agency where he has taken up the medical policy. The doctor updates the medical record of the patient for further diagnosis, examinations, test, medications, and treatment (if any). The policy information can be confirmed by contacting the payer.
A qualified staff examines the medical record and translates it into certain procedural and diagnosis codes. The medical billing company analyzes the data and performs services for the provider. This agency either handles claims only, or takes care of both claims and billing. It is not easy to settle a medical insurance claim. The billing company has to charge and fill up, the amount and the form, respectively. Form filling should be done carefully; even a single mistake regarding the patient's details or treatments can lead to rejection and returning of the claim. Information in the claim should match with that in the policy document. Regarding any doubt, the billing agency can verify with the patient and the provider.
The claim is then submitted to the insurance company, where the patient has a policy. In some cases, it has to be submitted to a clearing house before passing on to the payer. This company further processes the claim. If there are no mistakes, it determines the allowed charge payable for each service depending upon the patient's policy, and accordingly payment is done. This marks the settling procedure for a medical claim.
Some medical billing services charge their fees to the provider, according to the number of claims handled, whereas, some prefer to charge for a percentage of what they collect. This is done mainly for the services provided by the medical staff.
Majority of the services use electronic billing systems with advanced medical billing software. All the main tasks like filling up the claim forms, submitting claims, and sending billing statements are done via the Internet. The advantages of using such systems includes saving time, and increasing efficiency and profitability.
Everyone must be aware about various health insurance schemes and their significance. Majority of the American citizens have medical insurance cover, which can be in the form of dental, individual health, or family health insurance. One can take up disability insurance according to the lifestyle and risks involved. It is very important for all the policyholders to have detailed information about the policy he/she has taken, while applying for any insurance. One should analyze the policy documents, and understand the coverage which concerns any particular scheme.
Certain problems may arise related to the claims submitted via the billing services, and the insurance company's payment. In such conditions, the patient's cooperation is very important. He/she should give detailed information about the policy, such as its coverage and related terms. If possible, the patient should call up the insurance company and inquire about the reasons for denial. If this agency denies the claim, then the patient has to pay the medical bills to the provider. For genuine reasons, the patient can file an appeal against such insurance agencies.