MEDICAL BILLING IS A PAYMENT PRACTICE WITH UNITED STATE HEALTH SYSTEM

THE PROCESS INVOLE HEALTH CARE PROVIDER SUMITTING AND FOLLOWING UP ON ,CLAIMS WITH HEALTH INSURANCE COMPANIES IN ORDER TO RECEIVE PAYMENT FOR SERVICE RENDERS;SUCH AS TREATMENT AND INVESTIGATIONS.THE SAME PROCESS IS USED FOR MOST OF INSURANCE COMPANIES WHETHER THEY ARE PRIVATE COMPANIES OR GOVERNMENT SPONSORED PROGRAMS.

TYPES:

THERE ARE THREE TYPES OF MEDICAL BILLING.

  1.   CLINICAL BILLING
  2.  HOSPITAL BILLING
  3.  OLD HOUSE BILLING           

         (IN OLD HOUSE BILLING , THERE IS EPISODE OF TWO MONTH FOR PATIENT RECOVERY..IN CASE THAT IN WHICH PATIENT WILL  NOT RECOVER THAN HE/SHE WAS GIVEN WITH NEXT EPISODE..)

                 

SUPER BILL:    THE PAGE GIVEN BY DOCTER TO SERVICE PROVIDER IS CALLED SUPER BILL

ON THIS THERE ARE CLAIMS OF PATIENTS

  ITS ALSO CALLED MEDICAL BILLING ,BILL BESIDES THIS DOCTER HAS TO RECORD HIS VOICE.

BILLING CYCLE :         THE MEDICAL BILLING PROCESS IS A PROCESS

THAT INVOLVES A HEALTH CARE PROVIDER AND THE INSURANCE COMPANY PRETAINING TO THE PAYMENT OF MEDICAL SERVICES RENDERED TO THE CLIENTS.THE ENTIRE PROCEDURE INVOLVED IN THIS IS KNOWN AS BILLING CYCLE ALSO REFERRED TO AS REVENUE CYCLE MANAGMENT.

REVENUE CYCLE MANAGEMENT INVOLVE ;

MANAGING CLAIM

PAYMENT

BILLING

CODES:     THERE ARE TWO TYPES OF CODES

DIAGONSIS CODES

PROCEDURE CODES

AFTER DOCTORES SEES THE PATIENTS THE DIAGONSIS AND PROCEDURE CODES ARE ASSIGNED. THESE CODE ASSIST THE INSURANCE COMPANY IN COVERAGE AND MEDICAL NECESSITY OF SERVICE. ONCE THE DIAGONSIS AND PROCEDURE CODES DETERMINED , THE MEDICAL BILLER WILL TRANSMIT THE CLAIMS TO  INSURANCE COMPANY . THIS IS USAULLY DONE ELECTRONICALLY BY FORMATING CLAIMS AS ANSI 837 FILE AND USING ELECTRONIC DATA INTERCHANGE TO SUBMIT THE CLAIMS FILE TO PAYER DIRECTLY OR VIA A CLEARING HOUSE.. HISTORICALLY, CLAIMS WERE SUBMITTED USING A PAPER FORM IN THE CASE OF PROFESSIONAL SERVICE CENTERS FOR MEDICAR AND MEDICAID.

INSURANCE COMPANY PROCESSES:

THE INSURANCE COMPANY PROCESSES THE CLAIM USUALLY BY MEDICAL CLAIMS ADJUSTERS. FOT HIGHER DOLLAR AMOUNT CLAIMS, THE INSURANCE COMPANY HAS MEDICAL DIRECTORSS REVIEW CLAIMS AND EVALUATE THEIR VALIDITY FOR PAYMENT USING RUBICS FOR PATIENTS ELIGIBILITY PROVIDER CREDENTIALS AND MEDICAL NECESSITY.APPROVED CLAIMS ARE REIMBURSED FOR A CERTAIN PERCENTAGE OF BILLED SERVICE . THESE RATES ARE PRE-NEGOITATED BETWEEN THE HEALTH CARE PROVIDER AND INSURANCE COMPANY .FAILED CLAIMS ARE DENIED OR REJECTED IS SENT TO PROVIDER,MOST COMMONLY DENIED OR REJECTED CLAIMS ARE RETURNED TO PROVIDER IN FORM OF EOB OR ELECTRONIC REMITTANCE ADDIVE.

DENIEL OR REJECTION:     REJECTION’ COMES THROUGH CLEARING HOUSE .

A REJECTION CLAIMS REFERS TO CLAIMS THAT HAS NOT BEENPROCESSED BY INSURER DUE TO FATAL EROR IN INFORMATION PROVIDED . COMMON CAUSE FOR A CLAIMS TO REJECT INCLUDE WHEN PERSONAL INFORMATION IS INACCERATE OR ERROR IN INFORMATION PROVIDED TRUNCATED PROCEDURE CODE, INVALID DIAGONSIS CODE. A REJECTED CLAIMS HAS NOT BEEN PROCESSED SO, IT CANNOT BE APPEALED.INSTEAD, REJECTED CLAIMS NEED TO E-SEARCHED CORRECTED AND RE-SUBMITTED..

DENIEL COMES THROUGH INSURACE COMPANY.

A DEINED CLAIMS REFERS TO CLAIMS THAT HAS BEEN PROCESSED AND THE INSURER HAS FOUND IT TO BE NOT PAYABLE. A DEINED CLAIMS CAN USAULLY BE CORRECTED OR APPEALED FOR ROCONSIDERATION. INSURER HAVE TO TELL YOU WHY THEY`VE DENIED YOUR CLAIMS AND THEY HAVE TO LET YOU KNOWS HOW YOU CAN DISPUTE THEIR DECISIONS.

ELECTRONIC BILLING EDIT:    A PRACTICE THAT HAS INTERACTION WITH THE PATIENT  MUST  NOW UNDER HIPAA SEND MOST BILLING CLAIMS FOR SERVICE VIA ELECTRONIC MEANS.PRIOR TO ACTUALLY PERFORMING SERVICE AND BILLING A PATIENT THE CARE PROVIDER MAY USE SOFTWARE TO CHECK THE ELIGIBILITY OF THE PATIENT FOR INTENDED SREVICE WITH THE PATIENT`S INSURANCE COMPANY.

 

          

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Categories: Science