What is Medical billing?
Medical billing is when the healthcare provider submits, follows up, and approves claims from the health insurance companies to receive payments for services like treatment, diagnosis, testing, and procedures. It is a long, complicated process that requires the time and effort of healthcare providers.
Healthcare organizations provide the best medical billing services for medical practices. It includes a third party who takes all the responsibility for the workload and streamlines the medical billing practices to make you less pressured.
What Is MIPS In Healthcare?
Wondering what is mips in healthcare? MIPS basically stands for Merit-Based Incentive Payment System. It is software that has replaced PQRS, so we can say that it is a new payment reimbursement method in healthcare. The software comprises three old healthcare programs into just one payment software. It streamlined the following medicare programs; Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM) Program, and Medicare Electronic Health Record (EHR) Incentive Program. In addition, this software offers practitioners updates on annual performance. These updates are based on performance in four different categories.
Methods of medical billing services
1. Patient Check-In or Registration
Patient registration is the first step in any medical center. It needs all the patient’s information, address, age, gender, and telephone number. Moreover, insurance-related information also requires the insurance payer’s name, insurance plan, ID card/number, etc. The demographic information is essential information that should be updated and taken down carefully if the patient is regularly visiting the hospital/ clinic. Then, there is no need to add information again and again because it is already available in the medical billing and coding software.
2. Insurance Verification
Healthcare providers need to double-check and verify the insurance details because it can be directly on claim processing. Patients need to confirm their insurance data and requirements in each visit because status can change at any time. The medical services ought to ask for and double-check as it can have straightforward handling of the case handling of payment and claims.
The active insurance plans should be processed and handled, and if the referenced clinical benefits are covered or not, in any case, the patient needs to make a payment all alone. Any progressions in the security plan or strategy affect the patient’s approval data and advantage.
3. Patient-Provider Meeting
The first meeting with the healthcare provider is known as an ‘Encounter.’ The patients are always supposed to discuss the symptoms of their medical problem. The audio or video chat is also recorded to ensure the correct details, diagnosis, treatment and prepare claims accordingly. In contrast, the medical provider diagnosed the problem and provided the appropriate treatment.
4. Medical Transcription
Medical transcription can be used for medical billing purposes as well. An experienced and qualified healthcare professional will listen to the patient and examine the recording to document the medical script for later visits and checkups. It is an important step, and medical transcripts should be error-free; one mistake can affect the medical billing results, and also, one error can lead to claim denial or rejection.
5. Medical Coding
Medical coding decodes the healthcare treatments, diagnoses, procedures, and medical services into alphanumeric codes like radiology reports, laboratory tests, doctor notes, etc. Medical coding professional helps to ensure correct medical documentation, including abstracting, assigning, and creating claims done by health insurance companies.
The American Medical Association has given some instructions on which professional medical coder needs to be followed, it includes:
- The reason for a visit
- The diagnosis of a patient (disease)
- The treatment, services, types of equipment, tools and supplies provided to the patient
- Any incident or medical condition through which medical services, medicines are affected.
CPT (Current Procedural Terminology)or HCPCS (Healthcare Common Procedure Coding System) codes assign the method or service. It can quickly assess the amount the insurance companies make.
6. Charge Entry
It is the first and foremost step to prepare the claim form then, submitted to the insurance company because payment cannot be received without the charge entry. The claim form is to ensure the payment of claim rejection, denial or reduced amount. The medical claim form has the following requirements:
- Patient Information
- Patient’s medical history
- Procedures provided with correct codes
- National Provider Index (NPI) number and insurance provider
- Place of service code
7. Claims Submission
Claims are submitted through electronic media, a system called Electronic Data Transfer (EDI). The claims are ready for submission when you fulfill the claim form like patient information and provide insurance company services for payment or dues. There are three ways to submit the claims:
- Electronic Health Record (EHR) software examines the claim form is complete and the relevant coding.
- Outsider EDI individuals check the given patient data like name, Date of Birth (DOB), approach name, and coding errors.
- The insurance company also verifies the patient information and checks for coding errors in the policy and action. If there are any miscalculations, then the claims are returned to the health providers as rejected.
8. Claim Denial Management
Insurance companies have specific rules and regulations; the insurance company only processes those claims received on time or within a time limit. When the claim is accepted, then it is checked thoroughly. Sometimes if the claim is paid full, some part is paid and the other charges of the claims are denied. The medical organizations have a team to check the claims and then resend them if they are denied to recover the prohibited expenses and generate full revenue.
9. Accounts Receivables
Even after corrections are followed rigorously by the insurance company, the claims are denied, and further information is gathered that causes a denial of payment. The Insurance Coding, Medical Coding, and Charge Posting are assigned to check for any errors.
10. Payment Collection
The insurance company pays the claim through a paper cheque or electronic transfer when all the checks are done. Big amounts are sent with a report called Explanation of Benefits (EOB). The expert group at a clinical practice is liable for posting sections in the EHR programming software to coordinate with the received payment.
Benefits of Outsourcing Your Medical Billing
There are many benefits of outsourcing medical billing, and you should practice them, which are as follows:
More Time to Focus on Patients
If you outsource your medical billing to an expert medical company, it will grow more, and you will have more time to focus on your patients. It is very hectic to manage all the paperwork along with patient duty. It is time-consuming, and it is effort based work. Trust and hire a third party to make this difficult task easy for you, so you have plenty of time to spend with your patients.
Handing over your medical billing to an expert medical billing company does not mean that they own your company; it just means they are trying to fade away from your stress and pressure, and workload.
Stay Updated with Regulations
Technology is constantly emerging so do software and medical advancements. Medical billing and medical coding work altogether; they are the backbone of medical billing companies, so they need to stay updated with the new technology and regulations. Choosing any medical billing company will ensure everything on time without costly delays or denials. They work according to the latest trends, which is more beneficial for medical healthcare organizations.
As we know, the medical billers are third party experts, and they are efficient and accurate in medical billing and coding. They streamlined their process from the start till the end. They assure you the increased revenue by the precise billing process.
Choosing the best and advanced medical company for Outsourcing the medical billing process is vital for successful business and healthcare practice. According to your needs, having the right medical company supporting and accommodating is all you need.
UControl Billing offers advanced medical billing and coding solutions for medical centers like hospitals, health centers, and numerous physician clinics. They provide you with the best medical biller and coders who work efficiently! UControl Billing believes in quality work with affordable prices. Their cost-effective services and innovative software will add value to your healthcare practices and digital services.
If you want any kind of medical billing services, do not forget to visit UControl Billing. Contact us today to learn more about how we can transform your medical billing today.