The medical billing means preparation of medical invoice, maintaining the records of the transactions of the patients, forwarding the claims, coding, etc. The team of medical billing services works independently by acting as an intermediary between the hospitals and insurance companies.
So, the hospitals should pay excessive salaries to the accountants, financial managers, team of customer service etc. So, if they outsource their services to medical billing services, then they perform multiple tasks and also save their costs.
They provide the following services to the medical billing companies.
Role of the medical billing team
The appointments should be actually billed. After the doctor presents the records of the patients, then they should charge them for the services provided by them. The invoice is usually prepared by the accountants who mention the details of medications, surgeries or therapies. But, today this task is outsourced to medical billing services who prepare invoice of the patients. They also undertake some of the administrative activities to save the costs of the hospitals.
The medical billing services are also updated about the governmental rules, regulations, technologies, etc. so, they are trained to effectively use the natural resources and save the costs of the hospitals.
The revenue management services include the following.
The process of revenue cycle management
They verify the insurance eligibility of the patients and also enter their personal details and the amount to be paid towards them and hence they are engaged in payment posting in medical billing. The patients are usually assigned with CPT and ICD codes and the medical billing services verify if the codes match with the AMA approved codes. The codes should be entered correctly. The patients are provided with procedure codes also and they should not form the part of CCI credit. The administrative department or the medical billing department maintains file of every patient and each file should be authorized. The doctor’s name, which has referred the patient, should also be mentioned. The claims are initially sent to the transmitting house. Sometimes, the insurance companies sometimes do not pay the entire amount as demanded by the hospitals. So, the medical billing services negotiate between the two parties and settle their amount. They also provide the tertiary claims submissions to the hospitals. They should regularly maintain the records of the patients and also update their records regularly so that they can study about their condition and the amount that is payable. The tariffs, tax rates, services charges, etc vary from period to period and hence they should be updated by the medical billing professionals. The insurance companies should always pay the amount to the hospitals regularly whenever required. So, the team of medical billing services also access if the hospitals are receiving payments on time.
They also provide the physician credentialing and enrollment services to the patients. They maintain the CAQH profile of the physician and collect information from the physician. Then, they submit the applications to the insurance companies.
Then, the signed applications are sent to the insurance companies. The medical insurance and billing team regularly interact with the patients to ensure that they are satisfied with the services. They confirm to the doctor if the patient is participating in the insurance.