Medical billing process

What is the overall billing process?

After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.

What does a billing center do with respect to claims process?

A billing center's full service approach includes:

-- Claim entry,
-- primary and secondary electronic and computer generated hard copy claims,
patient primary, co-insurance and deductible billing,
-- the handling of all telephone and written inquires regarding claims and billing
--payment application and deposits,
--and insurance and patient follow-up on unpaid claims.

It should be able to provide electronic billing for all insurance carriers, including Medicare, Medicaid, Blue Cross/Blue Shield and NEIC companies and also a vast array of medical practice analysis reports, to facilitate
better management of your medical practice operation.

The needs of all medical practices are not the same. The billing center should
customize its services to meet the unique needs of each client. Whenever possible,
however, procedures and forms already in place should be utilized. The billing center should be able to adapt its protocols.

Parties in Medical Billing

There are three parties in the Medical Billing Process. The PHYSICIAN, The
INSURANCE COMPANY and The PATIENT. The Physician in order to attain his
objective should comply with the rules and regulations outlined by various insurance
companies in submitting claims and at the same time should not penalize the patient.

Types of Payers

There are various insurance companies in US. They are broadly classified into two.
Federal Plans and Private Plans. Federal Plans include the following within its fold:
Medicare, Medicaid, Railroad Medicare, CHAMPUS (Tricare), and CHAMVA. Private
plans are insurance companies that act as the payer. Examples of private plans are
Blue Cross Blue Shield, Aetna, Cigna, United Health Care, Prudential Health Care
and others. Private payer plans are subdivided into traditional indemnity benefit plans,
self-insured plans and managed care plans.
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Anonymous said...

"The Physician in order to attain his
objective should comply with the rules and regulations outlined by various insurance"

'Should' being the operative word. Good luck with that.

J. Ryan
Medical Billing Specialist

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