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[M355]Medical Billing And Reimbursement

by Michele Redmond, Mic

Medical insurance billing has become much more complicated in recent years. If a doctor is to be paid well for his services, the insurance billing is a very large part of his practice.

There is a lot more to medical billing than just sending a claim in to an insurance company and sitting back to wait for the payment. Each company has its own rules and in order to get paid, we must know them and follow them. How do you learn these rules and where do you turn for medical billing information?

Because it has become so complicated, it has become increasingly difficult to find employees who can handle this time consuming job. A doctor's office is a busy place and his employee may not have half an hour to wait on hold while checking on a claim, for a customer service representative to tell her that the claim is “not on file”.

Since their income, and ultimately the success of their office relies so heavily on the billing being done effectively, Doctors have found it increasingly cost-effective to outsource their medical billing to professionals who can concentrate solely on his billing. If the billing service is being paid on the basis of their results, the doctor is more likely to maximize his receivables.

The medical billing service is going to concentrate their efforts on getting every claim paid when the service is paid according to their results while a billing person in the office is more likely on a busy day to say “Forget it. This claim isn't worth another phone call!!” Unfortunately in most offices this claim will be written off and the doctor will never know.

There is so much involved with billing that most people, including the doctors, don't even realize. The claims have to be submitted properly, and timely, on the correct forms.

If claims are being submitted electronically, reports need to be read and acted upon. When payments are received, they need to be analyzed to make sure they were processed correctly, and then posted.

If there is a patient responsibility after payment is made, then a patient statement needs to be sent. If the claim is denied, or not paid properly, it needs to be handled, and handled quickly. If the denial or incorrect payment is not acted upon right away, you may not be able to correct it.

Some companies only allow a certain amount of time to request a reversal. Aging reports need to be run regularly to make sure nothing else is slipping thru the cracks. Most offices lose thousands of dollars a year due to claims slipping thru the cracks; either processed/denied incorrectly, or not processed at all. If you are not working your aging reports - you are losing money!

But the Medical Billing Services aren't getting rich like the ads portray. There is no simple easy way to do medical billing that the doctor's office doesn't know about.

There is still plenty of work to do to file the medical claims and get them paid. Don't expect that you can start this business without some background or education. There is much medical billing information you need to know to successfully run a billing business.

Medical billing is not a get rich quick scheme. If you are considering starting such a business, you should have a great interest in the field and a willingness to learn much more.

As with any other business you would consider starting, do your homework. Research the field, read as much medical billing information as you can and make sure you know what you are getting into. After all, it takes a lot more than a computer and a kitchen table to do a good job and run a successful business. Make sure you understand what is going to be required of you.

There is a lot of Medical Billing Information out there. Make sure the information you get is from a reliable source. With a growing field such as this, unfortunately there are also a lot of scam artists trying to sell you information that is worthless.

When a patient goes to a medical provider for surgery or to be put on medication, or simply to diagnose conditions the patient has been experiencing, there are certain costs for each service the medical practitioner provides to the patient. The provider records these costs in a form, usually a HCFA, or ?hic-fuh,? which can be either electronic or paper. The HCFA is then sent to the patient's insurance company, or sometimes to a clearinghouse or other middleman that can process the claim. When processing a claim, the insurance company looks at how valid the charges that the provider put on the claim are. Different companies have different systems for determining this, but in general it can be expected that about half the charges the provider put on the claim will be paid by the insurer, and half by the patient. Things like a deductible, co-pay, and coinsurance can have a heavy bearing on how much the insurer is willing to pay. If the patient has coinsurance, for instance, the insurance company is obligated to pay for a certain percentage of all the charges on the medical bill.

When the insurer has decided which charges are valid it returns the claim to the medical provider, in either electronic or paper format depending on their customs. Once received the medical provider looks at and analyzes the claim to see what the insurer has agreed to pay. If none of the charges were rejected by the insurer the provider then they will soon pay all the charges on the bill. If any charges were rejected, the provider must make changes to the bill and then return it to the insurer. If, once returned, the information on the bill is accurate the insurance company will pay it. But as with before, it might reject some of the charges, and if so the bill will be returned to the provider, and so on until the provider submits a medical claim the insurer can agree to pay the charges for.

Once the insurance company has agreed to pay for all the charges the provider has listed it falls on the provider to go to the patient to collect any unpaid charges.

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Both Michele Redmond & Joseph Hanoa are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Michele Redmond has sinced written about articles on various topics from . . Michele Redmond's top article generates over 1600 views. to your Favourites.

Joseph Hanoa has sinced written about articles on various topics from Mortgage, Government Grants and Acid Reflux. Joe is the owner of , the best site on the net if you are searching for information on. Joseph Hanoa's top article generates over 135000 views. to your Favourites.