Process of Medical billing 2019 - Medical Coding Jobs and Career

Thursday, June 20, 2019

Process of Medical billing 2019

The process of Medical billing: 

The steps involved in processing a claim and getting the payment for the physicians.

About Revenue Cycle Management:

What happens at Medical Billing in terms of servicing the client. At the end of the training you will be able to know how a doctor gets paid by the insurance What is Medical Billing companies and the steps involved in doing the CMS 1500 same.

What is Medical Billing?

Process of Submitting claims to the insurance companies in order to receive payment for services rendered by a healthcare provider. Simply we can say that “Managing Financial Transactions" for the Provider.

CMS 1500 :

The CMS 1500 is the current HIPAA approved standard paper claim form submitted to insurance companies to have the outpatient health benefit or the contracted provider visit paid. 

Most insurance companies desire to have the CMS 1500 form sent to them in an electronic format. The fields or blocks on the form are the same regardless if on paper or done electronically.

Denial Management: 

Denial is the process of handling the unpaid claim from the insurance. Insurance carriers deny claim if the claim doesn’t comply with the insurance policies. 

AR Management:

If the claims submitted by the billing company to the insurance is getting delayed or getting rejected, then it is the responsibility of the AR Calling to call the insurance company to find out why it is getting delayed or rejected and the AR analyst take necessary actions based on the analysis.

Objective of AR - Process:

1) Zero out the Patient Balance

2) Follow-up on the patient account which has outstanding balance from the insurance. To Ensure all claims have been received, processed and paid by insurance.

HIPAA - Health Insurance Portability and Accountability Act: 

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 requires: Part of the HIPAA Law (Privacy) HIPAA strengthened the privacy of the patient’s personal health information (PHI).National identifiers for Providers, Health plans, and Employers And also addresses the Security and Privacy of health data.

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