Health care billing services in the United States is provided by different organizations comprises of health insurance companies (commercial health insurance & public health coverage (e.g., Medicare, Medicaid)), healthcare providers, hospital systems, and independent providers. HealthCare / Medical Billing is the process of translating information from patient records, treatments, tests, procedures, and diagnoses into the standardized codes used to bill patients and third-party payers. Such as private companies or government-owned agencies (Medicare/Medicaid). The ICD-10 & CPT codes are extracting from clinical data charts and physician’s notes. Coding must be in compliance with the patient’s encounter with the physician and must be as specific as possible in regards to capturing reimbursement for rendered services.

Health Care Facilities

Health care billing services Or health care facilities are largely owned and operated by the Commercial Insurance Payers. The insurance coverage is provided through a combination of commercial health insurance and public health coverage (e.g., Medicare, Medicaid). People aged under 65 get insurance via employer or a family member’s employer, by acquiring health insurance on their own. Getting government and/or other assistance based on income or another condition, or are uninsured. Health insurance for public sector employees is primarily provided by the government in its role as employer. Managed care, where payers use various techniques intended to improve quality and limit cost, has become ubiquitous.

Health Care Software & Technology

During Health care billing services, healthcare software & technology helps in streamlining processes as it includes claim creation, filing & scrubbing, integrated clearinghouse and denial management tools. The software helps Medical billers & coders to process the patient treatment information into numerical codes ICD-10 codes and CPT codes which describes the medical services rendered for claim filing & reimbursement. To avoid revenue leakage, We need to address the common billing errors like  nonspecific coding; missing information; timely filling; incorrect patient identifiers; duplicate claims; up-coding & unbundling; and not supporting medical necessity. Due to the rapidly changing requirements by U.S. health insurance companies, several aspects of Health care billing services and medical office management have created the necessity for specialized training. Insurance payers offer different levels of coverage to their subscribers, and as the medical billing professional you must be able to understand payer contracts to follow-up on claims. As payers or networks have standardized contracts that they offer to healthcare providers. Medical office personnel may obtain certification through various institutions that may provide a variety of specialized education and in some cases award a certification credential to reflect professional status.

The health Care Billing Services Process

The health care billing services process that involves a third party payer, which can be an insurance company or the patient. During the health care billing services, medical billing results in claims. The claims are billing invoices for medical services rendered to patients. The entire procedure involved in this is known as the billing cycle sometimes referred to as Revenue Cycle Management. Revenue Cycle Management involves managing claims, payment and billing. This can take anywhere from several days to several months to complete, and require 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. Health care billing services providers are contracted with insurance companies to provide health care services. To be paid for services, medical practices need to establish financial responsibility and the medical billing professional must check Insurance Benefits, Preauthorization & Referral requirements, and Coordination of Benefits (Determine the primary payer if more than one insurance Coverages) to establish financial responsibility except in a medical emergency when care is provided immediately and insurance is checked after the encounter.

Challenging For the Practices to Process Billing

It is challenging for the practices to process billing with in-house staff because of the billing complexities, frequently changing regulations, new technologies. Insurance payers offer different levels of coverage to their subscribers and to avoid revenue leakage. We need to address the common billing errors to minimize the denials which boost Practice profitability & Cash flow.

Why you Should Choose PhysicianRCM?

Outsource Healthcare billing services can be beneficial for medical practices, as the billing companies have better control over the Revenue Cycle processes & are aware of any changes to the regulations and how that may impact the practice. At PhysicianRCM, we have worked with medical practices regardless of practice size, specialty, or collection. We believe that the precise insurance benefits verification directly impacts the reimbursements, minimize the Denials / Rejections, help to submit clean claims & to increase upfront collections.