The medical billing service process involves producing and filing health insurance claims or bills that are reimbursed for health services. These claims are submitted to insurance companies and patients with the intention of receiving reimbursement for medical treatments rendered.
Medical billing and bill-paying are two distinct but interconnected processes. Medical coders look over the patient’s medical chart during a visit, take data that can be used to bill, and translate that information into standard codes that appear on the invoice.
Medical billers are able to collect a variety of information for display in the CMS 1500 Form (for physician billing) as well as the form UB-04 (for billing at the hospital and facilities billing).
The Stages of the Medical Billing Process
It is a medical billing procedure comprising two primary phases, called the “front end” and the reverse end. The front-end billing process occurs prior to service (before patients meet with their physician). This usually involves front-of-office personnel who record all activities that involve patients.
Back-end billing is done after a physician has examined the patient. After a medical coder has completed the process of coding, back-end tasks can begin. These processes aren’t directly related to the patient and are a part of the claims management and reimbursement procedures.
Front-End Medical Billing
Front-end medical billing requires personnel to be knowledgeable about their healthcare organization’s payers. They also need to be aware of the requirements for insurance eligibility for payers that require prior authorization of services and any deadlines for filing.
The process of processing insurance claims starts when a patient makes an appointment with a doctor or signs up at the hospital. Front office personnel will gather the demographic and insurance details, which patients can provide on the registration form.
In order to ensure that the services are covered by a payment, Front-office personnel must verify that a patient’s health insurance plan covers the service to be provided.
Back-End Medical Billing
Medical billers need to maintain contact with doctors in order to gather details about an encounter with a patient or to confirm the diagnosis. Medical billers must be knowledgeable of CPT HCPCS Level II and ICD-10 codes and be able to examine medical documents.
The staff who handle charge entry will make use of an encounter form to record the procedure carried out and the reasons for it. Staff will then record charges related to the services in the practice management program.
After the charge entry process, medical billers go through their claim creation and process of scrubbing claims; claims generation involves assembling the charges and codes to create the insurance claims. Scrubbing claims ensures that all diagnoses, procedures, and coding are accurate. Medical billers often employ claim scrubbing software in order to determine and rectify any mistakes.
Why Use a Third-Party for Medical Billing Services
There are a myriad of advantages to outsourcing services, such as:
- A study from Software Advice showed that in-house revenue cycle management is able to collect around 60 percent of the revenue, while third-party medical billing firms are able to achieve a 70% success rate. This is an increase of 16.6 percent growth in gross income after subtracting the cost of making claims.
- Medical billing firms submit more precise initial claims and get fewer rejections. You’ll notice an increase in collection rates and fewer appeals.
- Medical billing services outsourced to you will confirm your patient’s insurance coverage when scheduling appointments and as much as four times ahead of scheduled appointments and the benefits that their insurance plans offer.
- The medical billing service might offer the option of identifying patients who have no (or incomplete) insurance details.
- Your medical billing service should offer the “pre-auths” option in certain areas, removing this tedious task from your team.
- This truly flexible service allows its customers to utilize their existing EHRs that are connected with the service billing system or is an EHR that is recommended or offers the alternative for no EHR, with the use of an electronic superbill.
The Convenience And Speed
Healthcare providers that use electronic health records (EHR) or an electronic superbill enable integration, enabling them to safely transfer the details to the system for billing medical bills and removing the requirement for office workers to scan and send documents.
In 2019, Software Advice calculated that a typical medical practice requires two staff members to manage medical billing on their own full-time. This same company would require just one staff member who devotes around 52 hours per year to the management of revenue cycles with an external medical billing service.
Medical billing service providers typically provide a range of trend analyses and reports. Some of them allow clients to produce custom reports upon request.
Third-party medical billing service providers make sure the systems they use are HIPAA-conforming and ensure that security measures are implemented in accordance with SOC 1. and 2.
Healthcare payers frequently alter their claims and the coding requirements. Third-party medical billing companies are currently on any changes to all payers to whom they submit claims.
How PerigonMed Can Help With Medical Billing
The perigonMed team of experts in consulting, developers, and trainers can improve accessibility by modifying the features and templates. This gives the user and your patients greater control over their data and greater transparency.
In our process of streamlining, we’ll help you implement our Patient Portal, API, and other tools that will improve safety, patient participation, and security. We offer the extensive tools you require to ensure compliance, from dashboards and automation to workflow design.
