Uncovering the Vital Role of Medical Billing in Modern Medicine

You’re not alone if you’re struggling to pay your medical bills! An insightful survey by the Commonwealth Fund reveals that 41% of all working-age U.S. citizens experience trouble paying off medical debt.

But if you’re unsure how to handle your hospital bill, you can outsource to a professional billing company. That way, you won’t have to stress about complex billing questions or medical debt notices.

This article will discuss the medical billing office, their tasks, and why you need a financial assistance policy for your institute. Further in this blog, we’ll dive into the differences between medical and hospital bills:

A Quick Glance at Medical Billing Offices

Medical insurance billing involves submitting a claim and follow-up as payment for services provided by medical care providers. Once a patient sends the claim, medical billers within the healthcare facility may offer remittance.

To ensure a smooth process, medical billing offices hire top-notch specialists who ensure medical providers receive their deserved reimbursements. Depending on the complexity of the claim, it might take several days or over a month to complete.

What Do Medical Billers Do?

A professional medical biller manages patient payments and insurance claims for a healthcare provider. In addition, they ensure patients receive compensation and accurate billing statements.

Most medical billers partner with multiple healthcare practices, such as clinics, hospitals, and primary care facilities. Here are the top responsibilities of a central billing office:

• Create accurate invoices based on filing codes
• Send a separate bill for doctors, nurses, and patients
• Submit claims to patient’s insurance companies via mail or email
• Send follow-up invoices to patients to remind them about insurance payouts
• Communicate with health insurance providers to track payment plans
• Confirm patient insurance coverage information by contacting representatives
• Look into denied claims to ensure the provider receives the deserved payments
• Manage patient payments and stay up-to-date with information

Medical Office Billing vs. Hospital Billing: What’s the Difference?

Contrary to popular belief, central billing office and health billing are not the same! While medical office billing covers claims for health care services by physicians, suppliers, and non-institutional providers, hospital billing focuses on those by nurses and hospitals.

In addition, a medical billing office will perform administrative tasks, such as greeting patients, check-in, financial assistance, etc., associated with the medical practice. Contrarily, a hospital billing office only handles billing and collection tasks.

However, medical and hospital billing offices provide in-patient and outpatient billing services.

Are Medical Billing and Coding Similar?

Although related, medical coding and billing are not synonymous. You’ll require both services for reporting healthcare services, procedures, and supplies; however, their responsibilities are distinct.

Medical coders help determine the billable information and convert it into standardized codes, whereas medical billers navigate patients and insurance plans to arrange reimbursements.

Steps Involved in the Medical Billing Office Process

Now that we’ve covered the basics, let’s dive into the services provided by medical billing offices:

Patient Registration

The registration starts with a patient needing to book an appointment on the phone with a healthcare provider. If the patient has seen the healthcare provider before, their information will already be present, and they need only explain their concerns and reason for visiting.

However, if the patient is new, they must provide basic demographic information, such as name, birth date, and insurance coverage information. Besides this, the customer service department may request additional information to ensure the patient is eligible for services.

Once the health care considers the patient’s personal and insurance information, the medical biller will review it and create a new file.

Financial Assistance

Different insurance coverage plans from varying policies and companies will manage and reimburse distinct medical processes and services. So, financial responsibility and assistance ascertain which insurance company owes payment for a particular doctor’s or physician’s visit.

Once the medical office biller collects the relevant information and supporting documentation, the patient is informed of any medical treatment or service not covered by the insurance company. The biller will set deductible limits and copayment schedules depending on your income.

 Superbill Creation

Once the patient checks in, the front desk representative may request them to complete a form or update information. Moreover, they might ask the patient to provide identification and a valid insurance card and collect copayments.

Furthermore, when the patient checks out, the medical records from the interactions will be converted into diagnosis and procedure codes. After that, a “superbill,” i.e., a report comprising relevant information, will be created.

Health Care Services and Diagnosis Coding

Accurate coding of insurance claims is crucial for informing insurance companies what treatments and services the client receives. So, a medical biller must leverage the appropriate diagnostic codes to identify illnesses, symptoms, and treatment methods.

Moreover, medical office billers must use the correct code modifiers to offer information about the patient’s services and procedures. Insurance payers may struggle to create accurate billing statements without the appropriate codes and modifiers.

Insurance Coverage Eligibility

Every patient has to verify their insurance info and eligibility before they schedule an appointment. Since insurance companies often revamp their plans, medical billers must ask patients for potential changes in their insurance information before every visit.

Any change in the insurance plan can impact the coverage, benefits, and authorization, so it’s worth reviewing before a patient checks in.

Prepare and Submit Claims

Medical office billers may utilize superbills to create a medical claim for the patient’s insurance company. After writing the claim, the biller must review it to ensure it meets the appropriate compliance standards, including format.

Once done, they will submit the claim to the patient’s insurance company for unpaid bills. But to ensure a smooth billing process, professionals must have the patient’s insurance payer’s data. The medical biller will typically electronically transmit the claim via a third-party company.

However, if your patient receives Medicaid services, they will only accept insurance claims from the healthcare provider.

Monitor Payer Adjunction

After medical billers send insurance claims to the payer, it undergoes adjudication. In this process, the payer determines whether the claim is compliant and the amount of reimbursement they will provide.

Patient Payments Preparation

A medical biller’s job does not end after submitting a claim. Instead, it would be best if you created insurance billing statements to collect outstanding charges.

The statement will include information about the medically necessary care, procedures, treatments, and services, alongside their cost. Besides, additional information may entail the amount the insurance company paid and that unpaid by the patient.

Statements Follow-Up

Lastly, the medical biller must ensure that all hospital charges are paid. In addition, medical office billers must follow up with patients with delinquent accounts or unpaid hospital bills.

Furthermore, they may have to send the patient’s account to a collection agency when necessary.