Medical billing refers to the process of making and settling claims by the healthcare provider to the insurance companies for facilitating a patient who is on the panel of the insurance company. A billing cycle refers to a process in which a claim is made by the doctor to the insurance company or the payer for the services rendered by them to the patient who is on their panel.
The medical billing process is an interaction between a healthcare provider and the insurance company (payer). The entirety of this interaction is known as the billing cycle and is sometimes referred to as Revenue Cycle Management. This can take anywhere from several days to several months to complete, and requires several interactions before a resolution is reached. The relationship between a health care provider and insurance company is that of a vendor to a subcontractor. Healthcare providers are contracted with insurance companies to provide healthcare services.
Each time an insured patient receives medical treatment from his or her designated healthcare facility, the healthcare facility is bound to submit and file a claim for the expenses of that particular treatment with the insurance company. The healthcare provider will include information such as the age, name, nature of illness, diagnosis, reports, period of treatment and the quality of service provided to the patient. And in some cases the comments and remarks of the patient as well.
The insurance company receives the claim file and then reviews it before investigating on its own. They verify each and every component of the file and if there is no ambiguity or error found, they settle the claim.
For a very long time the whole medical billing process was being done by the healthcare provider. They had to hire clerical and technical staff for that purpose and had to dedicate resources towards the practice. But now a days a new trend of outsourcing the medical billing is flourishing rapidly.
Outsourced medical billing refers to a process where a third party is hired by the healthcare provider to submit and settle medical billing claims on their behalf. These companies hire professional people who have years of experience in dealing with insurance companies. They complete the case files and then keep a follow up with insurance companies until the claim is settled. Outsourced medical billing companies are thought to have an in depth knowledge of the working of insurance companies which helps them better understand the rules and regulations of medical insurance.
There are several benefits of hiring a medical billing company. First and foremost is the reduction in the operational cost of the organization. No need to hire or train extra staff. A medical billing service provider can provide you with comprehensive performance reports upon request. This results in better transparency and control over the proceedings by the healthcare provider. Plus, constant follow up results in better and quicker settlements of claims.
