Whether you are a new Provider or an established healthcare practice, providing extra care to the medical claim processing sector is the only way to improve cash flow. Although patient care is the key focus of Physicians, many are new to the industry and lack the experience to handle medical billing. Well, it doesn’t mean that experienced Providers are well-versed in claims processing, as some of them lack the latest technology & software or professionals skilled in the new healthcare reforms. In either case, outsourcing medical claims & billing is the best option! In order to learn why it is the right solution, Providers should understand how complex is medical claims processing and billing. This article emphasizes just that:
What is Medical Claim Processing? When Providers render medical treatment to patients, they get paid by sending out bills to Insurance companies covering the medical services. It involves a lot of steps. Firstly, claims are prepared by assigning specific ICD (used for diagnoses) and CPT (used for treatment) codes to the medical services provided. These claims contain important information like patient demographics and plan coverage details. Then, the claims are submitted to the Payors. The insurance companies evaluate each claim and reimburse it accordingly.
Medical Claim Billing in Depth: Medical claim processing is not as simple as a walk in the park. It is a complex task that can be carried out only by skilled professionals who have great attention to detail, immense training in the new coding techniques, good communication skills, and knowledge of current healthcare trends. To be qualified by the Payors, claims have to go through many technical protocols and pass industry standards. HIPAA is one such standard that ensures high-level security during patient data transmission. Processed claims are filed electronically to expedite the process and improve efficiency.
Clearinghouses: The next step in medical claim billing is clearinghouses to which processed claims are sent to. It is a third-party hub that operates between the Provider and the Payor. Clearinghouses sort out all claims, scrub them for errors, format them as per industry standards, and send them to various insurance carriers.
Explanation of Benefits: After evaluating the claims, the insurance companies reimburse the Providers or reject erroneous claims if any. They should also provide EOB (Explanation of Benefits) to patients as well as Providers. EOB is a statement that shows several details like dates of treatment, diagnoses, charges, Providers’ reimbursed amount, and patients’ financial responsibility.
Why Outsource? Anything can go wrong in this huge, complex process. Therefore, the in-house billing team should perform medical claim processing exceptionally well and conduct multiple audits before filing claims. If the team is not competitive enough to handle, then Providers can opt for outsourcing medical claim billing.
About MGSI:
If you are on the lookout for an experienced medical billing company, then consider MGSI, which has more than 28 years of experience in the healthcare domain. Based in Florida, this company possesses the latest technologies and software solutions to process claims without errors. MGSI is A+ rated company with Better Business Bureau. To learn more details, log on to www.mgsionline.com.