Medical billing and collection are two critical aspects of revenue generation for a clinic, medical care facility or private physician. The processes involved are not as easy to execute and can get quite messy. Medical billing and collection is a broader term that encapsulates billing, claim filing, follow-ups etc. and it is one of the ways to ensure that the physicians and clinics earn their revenue.
One complicated element that the billing process entails is outstanding bills or unpaid bills. To collect these debts, timely follow-ups are a must. It has become increasingly evident that due to a lack of proper billing procedures and non-payment of overdue bills, medical practitioners and their practices are losing out on a lot of money. A solution to such a problem lies in securing the help of medical billing experts.
What does medical billing and collection mean?
In the US, medical bills are usually covered by insurance. Therefore, medical billing service is the process of collecting insurance information from patients. Medical billing experts are responsible for collecting this information. Once the precise information regarding a patient’s diagnosis, testing, treatment and procedures are gathered, an insurance claim is filed that appeals for the payment of the rendered services. This job requires time, constant follow-ups, and negotiations with the insurance carriers.
Bills going to collection is the next stage of filing a claim. Collection of a medical bill refers to those medical bills that are overdue as a result of claim rejection. This could be due to many reasons – like a claimed treatment not being covered by insurance or patients buying unrelated items on medical insurance. When a medical bill is turned over to a collection agency, it means the healthcare provider is no longer responsible for the recovery of that bill.
Medical billing and collections often get complicated. Medical billing experts are best trained to see through these jobs. Training and experience in the domain helps them to be aware of medical billing and collection tips. These hacks make them experts in recovering bills.
Hire a medical billing expert and save 70%
As a process, medical billing comprises many functions. The core function of billing experts, however, is to ensure that every bill generated for procedures, treatments and medicines is taken care of and paid for. To ensure the same, these experts have to exclusively devote time to the job. Their responsibilities include communication with physicians or other healthcare providers on a daily basis to get precise information on treatments, procedures etc.
Can a physician take care of these non-medical tasks while attending to patients? It might not be an impossible thing to do but for a physician, filing insurance claims cannot be the sole focus. Engaging the services of medical billing experts on the other hand can not only solve this dilemma but also aid with the streamlining of all billing needs. When a medical practitioner or healthcare professional decides to hire a medical billing expert, it directly translates to flawless billing, which consequently ensures revenue generation as bills start getting cleared regularly.
How medical billing experts help
One of the most effective ways that a medical billing expert can help a medical practitioner is by taking care of the billing aspect. Outsourcing is a major part of this arrangement. Offshore locations mean medical billing and collection can be handed to the same service provider.
Once a claim is filed with an insurance carrier, they will have a lot of queries. Without a medical billing expert, the physician becomes the only point of contact for them. The physician’s phone will be ringing off the hook. With patients to attend to, unanswered insurance queries will remain unresolved. This will inevitably mean delays in processing claims. With a billing expert taking care of the queries at this crucial stage, physicians and healthcare workers will be able to focus on their jobs at hand. With insurance queries answered on time, swifter bill settlements will also become the norm.
Report generation of settled bills, due bills, litigated bills etc. also means a huge amount of work. However, many outsourced medical billing experts use automated systems to sort through these bills and generate impeccable reports on schedule. These reports can be generated on a weekly, monthly or yearly basis.
HIPPA compliance is mandatory for medical billing experts. HIPPA compliance means that every medical provider and biller is covered by HIPPA and he or she has to submit the medical bills electronically. HIPPA already has a pre-approved format for the same and this format accepts the approved codes of billing.
Medical billing in the US gets a little technical. However, medical billing experts, juggle these terms and codes every day. Hence, they know how to file a claim. A physician who tries to do the medical billing himself or herself would have to learn about HIPPA from the perspective of medical billing and then work through the bills.
Private physicians feel the need for medical billing experts the most. They run their clinics as not only health care centers but also business centers. It means that unless they hire help, the physicians themselves would have to get involved with insurance filings, claims and even complex laws and regulations. This leads to “eroding physician autonomy”.
What does the term “eroding physician autonomy” mean? When claims are filed, many are often rejected by the insurance carrier. One of the reasons for this is the non-coverage of a particular procedure or treatment. Unless a physician is aware of how such bills can be worked on, they will lose money. This also means that insurance companies try to dictate procedures and encroach upon the specialized field of medical treatments. This is one of those facets of medical billing that a physician can completely forget about when a medical billing expert handles the claims.
The mechanics of insurance and billing procedure are specialized fields of expertise. When a physician tries to handle all the nuances of Medicare, Medicaid and insurance covers, the processes as well as the streamlining of documents and reports may go haywire. Private physicians trying to handle their own medical billing has resulted in revenue losses. There are medical billing and collection tips that help medical billing experts to ensure their claims go through. Eventually, bills get paid.
Medical billing experts are trained professionals who are aware of how medical insurance bills work. In the course of their tenure, they also develop a network of people that they deal with on a daily basis. Interpersonal skills help medical billing experts network well within the community that in turn helps them in streamlining a lot of the insurance claim work.
Read more: Mediclaim Vs. Health Insurance: Which One Is Best?