From One Hygienist to Another
From One Hygienist to Another
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Lindsey97

What to Know About Billing in Your Practice

What to Know About Billing in Your Practice

5/8/2019 3:12:49 PM   |   Comments: 0   |   Views: 10

Medical billing refers to a payment practice where healthcare providers including dentists, orthopedists, nurses, and doctors submit and follow up claims after sending them to the insurance companies. It speeds up payment for services rendered such as investigation and treatment. Medical billing was in the past done manually where claims would be filed and submitted on paper. However, healthcare providers can now send and manage applications and receive payment for services rendered efficiently with medical billing software. These are a few things to know about medical billing.

Medical Billing Serves as a Bridge

It bridges between the insurance company and healthcare providers. Medical billing refers to when a nurse or doctor sends an invoice detailing medical bill and treatments received by a patient to the insurance company for payment. The invoice is referred to as a claim. Your insurer can sometimes pay all the claim or pay part of it depending on the terms of the health insurance. That partial payment is known as co-paying. One thing medical insurers are good at is their tendency to alter and lower the medical cost and inability to pay up. Perhaps you have heard horror stories where the insurance company has contested insurance claims, leading to denied health care for a car crash victim or loss of income for a healthcare facility. That has prompted some hospices and hospitals alike to increase the cost of their medical procedures significantly as they try to make up for the cost of hiring the services of medical billers or any other financial loss.

Use of Specialized Software

Medical billers use specialized software for accuracy. Medical billers are responsible for preparing claims for insurers and negotiation for the remuneration and reimbursement of their establishments. Medical billers are also tasked with processing patient data, related insurance information, patient’s diagnosis, and treatment records. Given the tasks that medical billers have to handle each year, the therapeutic billing process can be cumbersome. However, billing services and medical billers utilize specialized billing software to reduce the risk of error and manage insurance claims and client information efficiently. Absolute Medical Billing, a physician-founded services uses software to streamline almost all spheres of the billing process ranging from managing insurance to patient billing, patient’s payment, and claim submission. The cloud-based medical billing software allows healthcare providers and billers alike to access insurance claims and medical records from anywhere. That’s why healthcare facilities are opting to outsource their billing services from medical billers. 

Improved Bottom Line

Medical billers can help a medical practice bolster its bottom line. Professional medical billers have been a staple of medical facilities. Knowledgeable medical billers do more than just filing and following up insurance claims. Health facilities with medical billers have recorded better financial reports than those without. Medical billers prepare insurance claims and follow them up to ensure that medical practices receive payment for the rendered services. Medical billers also communicate with doctors and other caregivers to clarify the diagnosis and gather more information about your treatments and medical costs. Of course, no one would want to be slapped with a medical bill that isn’t related to the procedure and treatments they received. That means that the financial health of a doctor or any other caregiver not only depends on the patronage of the patient but the excellent performance of a professional medical biller as well.

Outsourced Medical Billing 

Patients sometimes outsource medical billing services from a medical billing service. Recent research has found that there are far fewer healthcare facilities in the United States than there were a decade ago. Many medical facilities are starved of the necessary flow of cash with hospitals getting as little as 10 percent reimbursement of the total cost of health. For a medical practice to thrive or even stay afloat depends on its billing department. The more claims a medical practice can get the insurance provider to pay and more statements they can give patients, the faster it can to bring money into its finance department. Most healthcare facilities handle their medical billing in-house, where a worker or a team dedicates to running the medical billing department. However, medical practices can outsource their medical billing from medical billers as well.


Outsourced medical billers usually send claims on behalf of healthcare providers or patients to the insurer and are responsible for following up on all denied and unpaid claims. Outsourced medical billing companies can handle everything regarding medical billing in time and leave patients to concentrate on their recovery and caregivers to focus on administering treatment. Another reason people prefer outsourcing medical billing is that you can assess the performance of the biller objectively. Outsourced billers are required to provide their clients with an up-to-date report on their progress. The report not only enables a client to see how far the billers have progressed but also evaluate the overall performance of the billing provider. Visits to doctors and hospice can over time become expensive, and recent research has shown that high debt from care expenses is one of the reasons many Americans file for bankruptcy. Gorging of medical costs by insurance companies and inflated health costs is another reason for this. One of the mistakes that the medical billing community often make is duplicate billing where the medical billers bill the insurance provider twice and the client as well. Another annoying error is when the biller charges a client for each procedure separately including the ones that would have gone together. 

Steps for Successful Medical Billing

No matter how complicated and complex medical billing can be, it is possible for things at a health facility to go as planned and run smoothly. That means it is possible for a patient to file an insurance claim and pass it through the medical billing process once instead of having to take it through several repeated steps. Medical billing software programs have helped reduce the time it takes for the insurer to pay a claim. Working with an expert in the medical billing space has over time become crucial as well. Unfortunately, some patients think they are knowledgeable and can navigate the billing process on their own even when they can’t.

Insurance Verification and Eligibility

Of course, even regular patients have to verify their eligibility and insurance information before every appointment with their caregiver. Patients have to double-check their insurance information often as it can change at any time. A change in the insurance information can alter their authorization information and their benefits as well. So, it is worth double-checking your insurance information than wait until the last minute.

Patient Check-in

The notation of the demographic data of a patient should be the first step of the appointment with the biller. Patients should also submit their policy number, insurance payer, and insurance information to the biller for quick claim payment. The biller should detail any information that will be necessary or useful in filing for a claim at patient check-in.

Medical Coding of Modifiers, Procedures, and Diagnosis

The insurance payer relies on the claims coding to know what the patient is being treated for and all the procedures they are likely to undergo. As such, healthcare providers should use the correct diagnosis codes to describe the methods of treatment as well as patient’s illness and symptoms. Accurate HCPCS and CPT code modifiers can provide additional information about the procedure or service that a patient received. Your insurance company can only make an accurate assessment if you provide them with correct modifiers and codes.

Claims Submission

After filing the claim form and double-checking it, next is to submit it to the insurer for remuneration and reimbursement. However, medical billers should have access to any information regarding the insurance provider because the procedure for filing a claim tends to vary across insurance companies. Though health insurance providers follow a standard set of medical billing guidelines, some have a separate way of paying claims. Check with your insurance company because some medical billing aspects are insurance provider-specific to make sure you adhere to the guidelines for submitting an insurance claim. 

Charge Entry

It refers to entering charges for the procedures a patient went through, and patients received. It also includes linking medical codes and modifiers to surgeries and services that a patient received during their visit to the doctor’s office or hospice. 

Payment Posting

It is the last step in medical billing, and it is all about deposit and posting functions. The amount billed to a car crash victim will be zero at this point if the insurer has paid the claim fully. The bill will reflect the amount that the insurance company owes the client. The insurance company must have met its responsibility by the time the billing process gets to this stage. With these steps, the billing process should be smooth and quick. Medical billing may sometimes seem complicated and overwhelming, but with the right procedure, it shouldn’t be as challenging as medical coding. However, shopping around for affordable health insurance package and garnering as much information about billing statements and medical charges is the first step for patients to protect themselves against inflated medical bills.


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