How Medical Claims Processing Works
The process of medical billing involves the hospital sending documents to the insurance company showing the amount owed due to the medical treatment offered. This process is done with all insurance companies, from government sponsored to private. Medical coding includes all the details regarding the diagnosis and treatment of the patient.
The insurance companies have provided people with a chance of accessing quality and affordable healthcare across the country. They have had a positive impact on the way healthcare is provided in the country.
Traditionally, the process of filing medical billing was entirely done on paper. The whole process was handled either through postal offices or through a fax machine. Time wastage was common before both parties came to an agreement.
However, with recent changes in technology, this process has been made electronic. Manual work of filing medical billing has been replaced by the medical claims processing software. The speed of EDI Billing has injected speed in filing these documents thus allowing parties to get to agreement fast.
The health information system has allowed hospitals to manage a huge number of claims at once. It has allowed room for instant feedback and real-time update of data. The process has also opened doors of opportunities for many people and has resulted in the formation of big companies.
Technology companies have also played their part in providing hospitals and insurance companies with the best software to fit their needs. The claims processing software has also improved the channel of communication between the vendor (health insurance) and the subcontractor (hospitals).
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Another industry that has been on the rise is the medical billing clearinghouses. The main function of these clearinghouses is to act as intermediaries where they forward the medical claim from the hospital to the insurance firm. They also conduct a process known as claim scrubbing which is to regularly check the data for any errors. Another function is to determine if the claim provided by the hospital is indeed compatible with the claims processing software of the health insurance firm.
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The process of medical billing may take a long time to complete and it is complicated even further if the payer and the provider are enrolled in two different clearing houses. This means that the claim will be forwarded from one clearinghouse to the next and the process might go to and fro. It also means that the chances of your claim becoming stale or getting lost will also increase.
It is always better to ask your claims clearinghouse where the claim will go after it leaves their office so as to avoid any unnecessary delays or loss of information and data.