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How Medical Billing Software Works

Medical billing is a process by which the health insurance company claims are being followed up and submitted.  This is done in a way that a certain health care provider can get the payment for the services being rendered by them.
How it Works
An interaction is made between the insurance company and the health care provider, which could either be an accredited private or public hospital, medical or dental clinic or a diagnostic health center.   This whole agreement between the said institutions is called billing cycle or Revenue Cycle Management which needs numerous interactions to come up to a solution which may take a long time for completion.
The health care provider acts as a vendor and the insurance company as the subcontractor.  Insurance companies will contract the health care providers to render such health services. 
As the insured patient used the service of the accredited health care provider, even if it’s just a check-up or a confinement, his medical records will be updated and then codes for the diagnosis and procedures will then be generated.  The codes will help insurance company to determine up to what extent the medical service covers.
After determining the codes, the medical biller (health care provider) will inform the insurance company about the claim which is done electronically by formatting as ANSI 837 file.  It uses Electronic Data Interchange in submitting the filed claim directly to the insurance company or through a clearinghouse which is usually an organization who collects and gives out information regarding specifics.
The claims are then processed by the medical claims adjusters of the insurance companies.  After the claims had been approved it will be paid back to the health care provider. 
Types of Claims
There are times that claims get failed sometimes because the health service provided is not covered in the agreement or there are some missing or incorrect information that should be corrected and provided.
Denied Claim is already a processed claim however insurance company found it not payable.  It can still be reconsidered through amendments and sometimes appeal.
Rejected Claim is not processed by the insurance company because of the mistakes or incorrect information being provided.  These include a mismatch on the identification number and full name and the generated diagnosis codes that are not valid.  It can’t be amended since it’s not processed.  It will be researched, then corrected and should be again submitted.
Medical Billing Software Advantages
·         Since it is fully automatic, you can easily pull up a patient’s records as to when the visit or confinement happened, the place of the check-up (could be the name of the health care provider) and how much is the total due.
·         Because of the use of the computer including the software, there is less paperwork.  Organizing and filing of the records are a breeze and much easier to retrieve with just a click of the button.  This saves time and space in the office as well as reducing the clutter.
·         Using Medical Billing software is cost-effective.  You may say that the price is high, but compare it with the cost of hiring additional employees to get the job done. You will have the software for just a one-time payment but will be able to use it for many years.  There is a lot of affordable software out there, find the one that caters best to your needs.
·         Patient information is accessible.  Just type in the name and identification number or any methods when pulling up a record.   In just seconds the information you need is already in front of you.
·         Errors are minimized and corrected smoothly without a trace of the liquid eraser.  As you type the information, the software has a feature that will inform you if certain information being entered is incorrect.


How Medical Billing Software Works Reviewed by Dex dela Cruz on 1:56 AM Rating: 5

1 comment:

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    Medical Billing Software

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