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Medical Billing Blog
Posted on March 17, 2011 by · Leave a Comment
Filed under: Medical Billing, News  

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A Medical Billing Services company provides the billing and reimbursement of fees for medical and healthcare services provided to patients. A Medical Billing Services Company processes and sends the claim to an insurance company. They follow up on claims, communicate with patients and insurance companies about claims that are denied or pending. A Medical Billing Service sends statements to the patient and turns past due accounts over to a collection agency. A Medical Billing Service does not manage the practice. A Medical Billing Specialist submits coded claims and statements. They use CPT and ICD9 coding to appeal denied down-coded or incorrect claims which can get complicated.

Medical Billing Specialists will organize bills and statements, check for errors, negotiate with collection agencies and speak to patients about their insurance coverage. They can spend hours on the phone speaking to insurance companies. A Medical Billing Specialist will bill the claims electronically or complete the CMS 1500(HCFA). They will have knowledge of insurance guidelines including Medicare, Medicaid, Blue Cross Blue Shield, Motor Vehicle and Workers’ Compensation. A Medical Billing Services company has to be HIPAA compliant.

When a healthcare physician provides medical services to a patient, reimbursement is required. The Medical Biller collects the monies due. After each appointment they review the encounter forms or super bill and the patient record to find what services were provided. They will compare the doctor’s notes to the encounter form or super bill to confirm the correct codes for the services provided. They will check the insurance coverage and make sure they are billing not only the insurance company for the correct procedures, but the patient for the correct co-pay and deductibles. They will then prepare the invoice and submit the claim to the clearing house.

Once the claim has been sent, the Medical Billing Service will be responsible for collection of accounts receivables, co-payments, denials, appeals, secondary claims and the collections for past due accounts.

A very important issue is the communication between the Medical Office and the Medical Billing Services Company. The Medical Office has to make sure that all billing correspondence and checks are forwarded to the Billing Service. If the billing service does not have the proper paperwork they can waste valuable time and effort following up on claims that have already been paid and not forwarded to them. They also need to have the pertinent information to process the claim correctly. If they do not have the proper paperwork including the patient record, doctors notes or completed encounter form the claims processing may be delayed. A solution to this problem could be a separate P.O. Box for the Billing Service, or a lock box.

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