Medical Billing

In order to receive payment for your services rendered by your healthcare provider, you must go through the process of medical billing. Whether they be private insurance companies or government owned insurance such as Medicare.

For several decades now, the process of medical billing was done almost completely on paper, therefore making the process weeks even months before you or your insurance company were paid for services rendered. Now due to computers and the internet, it has become possible to efficiently and quickly manage large amounts of claims in a much shorter time span. Many software companies have made it possible for medical billing to be done easily and cost efficient for the consumer and the medical facilities. With the multitasking features of medical billing software, you can work on several things at once. Enter data, print reports and schedule appointments without stopping what you are doing. Therefore saving time and money for everyone involved. There are several companies which offer full portal packages through their own web-interfaces, which cuts the cost of individually licensed software packages for a companies medical billing.

Software companies and medical offices have spent thousands of dollars for new technology, just for the medical billing process. With the introduction of HIPAA (Health Insurance Portability and Accountability), insurance companies, health care providers and patients were required additional waivers and paperwork. With this being, they were forced to redesign the business process and software in order to become compliant with the new HIPAA act.

Your billing process will begin at your doctors office. The diagnosis, treatment and time of service combined will determine the procedure code that will be used to bill your insurance provider. Your doctor will then either provide this information to their medical coder or their billing specialist. From this, a billing record whether by paper or electronic will be generated.

Your billing record or claim will then be submitted to a electronic clearinghouse or directly to the insurance company. Clearing house electronic claims software is available with the medical billing software that allows you to send claims to most insurance carriers, using the clearing house can prevent errors, reduce rejections and shorten payment times. From this point, your insurance company will process the claim. First, the insurance company must test the validity of the claim for payment. These tests will cover the patients eligibility for payment, the health care providers credentials, and the medical necessity. If passing the medical billing tests, the insurance company will then pay the claim. If for some reason the medical billing claim fails these tests, the health care provider will reject the claim and communicate the rejection message to the claim submission source. This exchange may repeat multiple times until your claim is paid in full.

As of July 1st, 2005, most medical providers that file electronically, will have to file their electronic claims using the HIPPA standards in order to be paid. Resources