Medical Claim Billing Service | Medical Billing Companies for Healthcare Claims Services

What Type of Information Does a Medical Claim File Contain?

Each medical file includes specific details of every patient. In a medical claim file, these details are split into two parts:  the claim detail and the header.

Claim Header

It includes the summary of the most important information in the claim. The claim header usually refers to confidential patient information such as gender, date of birth, and zip code. Besides that, the claim header also contains information like:

·         Primary diagnosis code

·         NPI or National Provider Identifier for the service facility and attending physician

·         DRG or diagnosis-related group

·         Inpatient procedure

·         The overall charge for the claim

·         Name of the client’s insurance firm

Claim Detail

It includes detailed information about procedures or secondary diagnoses provided during an inpatient hospital stay. Every service record or new claim details includes the following information:

·         Procedure code

·         Date of service

·         NDC or National Drug Code

·         Procedure code

·         Corresponding  diagnosis code

·         The charge for the service

·         On-duty physician’s NPI number

What is the Claim Process in a Medical Billing Company?

Though you can create an in-house medical billing team, it will cost you exponential money and great stress. You need to practice ways to retain the best talent and regularly update your software. On top of that, you need to provide regular training to the staff to keep them updated with the changing laws. Running a medical billing team in your hospital or care is an added responsibility for the medical provider.

Hiring a medical billing team is critical. They provide you with top-notch services and make the medical billing process seamless. When hiring a billing team, you will have experts in the field on your side. 

The medical claims billing service provider will perform the accurate billing process to ensure the results. These steps decide the entire claim journey, from checking patients’ information to reimbursing money from patients. Here we have discussed every step in detail to help you understand how billing provider works.

Patient Registration

This is the first step of the medical claim in a billing service. Patient information is registered when patients give their personal and insurance details to clinics, hospitals, and other practices. It’s important to collect and store this data accurately to fill claims accurately.

Insurance Verification

Once the patient is registered, the billers need to verify the patient’s insurance. This step determines whether the patient has adequate coverage for treatment and care without paying it from pocket. Insurance eligibility validation is also critical to check if the patient is eligible for the treatment. Besides that, it will allow billers to get the answers to the following questions:

·         Do the insurance agency of the patient need pre-authorization?

·         Has your patient accumulated out-of-pocket expenses, co-pays, or deductibles?

·         What type of benefits does patient policy offer?

Entry of Charges

The best medical billing services add the charges they should get at the end of the care of patients. Providing the right amount of money for every service is important to prevent loss.

Medical Coding

This is an important but complex step that requires great training and understanding of coding to avoid making mistakes. The billers will do it once the patient gets the medical service. Medical coders will transcribe healthcare-related documentation like doctor’s notes and lab results into specific medical codes.

Converting medical information into codes is crucial because hospitals provide different services to patients with different diagnoses, drugs, lab tests, and other things. It’s challenging for the experts to understand a bundle of information. Therefore, billers use unique codes to describe which procedures, diagnoses, and prescriptions the medical staff has administered to streamline the process.

Moreover, they use different types of these systems based on the type of medical practice and services they provide. Here are some of the most common coding systems:

·         National drug code or NDC

·         Healthcare common procedure coding system or HCPCS

·         Current procedural terminology or CPT

·         Diagnosis-related group or DRG

Transmitting Claims to Payors

Claim transmission is performed to transfer a claim from the practice to the payor or insurance provider. In general, billing claims are first sent to the clearinghouse. They review the claims and reformat them if necessary before sending them to an insurance agency. But the best medical billing service can also send them directly to the insurance company. This reduces the time each claim takes to receive reimbursement.

Adjudication

Adjudication is when the insurance company receives your claim. The company will review the claim and check whether it meets its policy. They will also check the patient’s eligibility to get coverage. Once the insurance provider checks the claim’s authenticity, they will evaluate the claim amount they can reimburse.

If your claim gets accepted, the insurance company will reimburse and charge your patient for any remaining amount. However, the insurance coverage provider has the right to deny the claim if the patient is not eligible for the coverage, has insufficient coverage, or has not applied for pre-authorization for the medical treatment or care.

Whatever the reason for the denial, the medical billing provider can assess the claim, improve it, and then submit it again for approval. Your patient can also submit the appeal to get medical coverage to avoid paying for the services from their pocket.

The experienced medical team can easily identify the reason for the denied claims. The team of experts looks for errors in medical coding, formatting issues, inaccurate information, and other things to ensure they get approval on the second attempt.

However, when you hire leading experts in the industry, more than 99 percent of your claims will get accepted. Hence, less risk of denied claims, meaning less risk of not getting paid on time.

Create Bill Statement

Once the claim gets approval, the billing team will create the patient statement, which is the final step. This bill will include information on any remaining amount of services patients need to pay. The bill amount varies based on the care they get and their days at the medical care facility.

Reasons to Hire Revenue Cycle Management Company

Medical claims billing service providers offer billing services that are otherwise challenging. They have the responsibility to improve the cash flow of your business while you can put your energy and time into improving your services. Some more advantages of employing a billing company are:

·         Fast and efficient workflow of healthcare practice without overburdening the medical team

·         No risk of confusion in dealing with different insurance companies’ payment policies

·         Few claim processing mistakes and submission errors

·         Claims are submitted at a rapid rate

·         A proper review process is done to ensure practices are reimbursed the full amount

·         Rejected or denied claims are resubmitted

·         Patient satisfaction rate  increases when claims are processed quickly and timely

·         The stress level and workload of the patients are reduced.