Medical Billing Process
Managed Care Organizations:
This category inclue HMO and PPO that is Healthcare Maintenance organizations & Preferred Provider Organizations. Patients can choose the insurance providers. These premium are fixed and basically lower. Since this insurance is lower in cost. This insurance policy is comparably popular in all over the world.
Every Insurance policy has its procedure and Rules. The main job description of Medical Biller is to interpret a insurance plan and health care provider.
Insurance Claiming Process:
Insurance Claim is directed with Medical Billing and Medical Coding. Medical Biller takes the process and procedure, medical coders diagnose the codes to create the basement for claims.
Coders:
Medical Coders take the procedure, whether it is Curent Procedure Terminology or Healthcare Common Procedure Coding System. Medical Coders perform Diagnosis Codes, ICD Codes and Demonstrate the medical necessity. Medical Codes tells the patients visits and diagnosis and the purpose of visit.
Billers:
Medical Billers adds information about the patients and patients visit, along with the cost of the procedure or procedures performed, to the claim. So the claim now has a what, why, who, when, and How..
Insurance Claiming is a complicated process, as a medical biller the executive must know what the procedure and later fully evaluate the procedure and work for reimbursement. These medical billers give it to the insurance provider and after accepting the procedure the payer will check the docuements and approve for the payment.
Activities of the Process:
Though we have standard long and complicated process, let me give you few easy ones.
Activities with patients:
Medical Billing process starts when the patients takes medical services from the health care provider. These providers will raise the bill for the patients. The medical biller create the request from the healthcare officials and they check the existing balance of the policy and deduct the amount covered by insurance companies.
Medical Coders will make a accurate code on medical serivces, billers abstract information from patients and coders diagnose technical codes.
Practice Management Software: The Medical coding executive use this PMS software to validate and maintain the records of the patients, so that they can recheck the details in future. These kind of management software helps the process to run it smoothly.
