The healthcare industries provide medical services to the patients who are suffering from different types of ailment. The patients should pay them some amount for providing medical services to them. They usually contact the insurance companies who can pay their claims to the hospitals directly. So, the hospitals maintain rapport with the insurance companies who can directly forward their claims to the hospitals.
But in the process of claim settlement, the role of accountants and medical billing department is significant. They maintain the track of the patients and help in settling the amount paid by the insurance companies, check the records of the patients, negotiate with the hospitals etc. Usually, the hospitals hire different type of persona to maintain the track of the patients, but they are incurring heavy expenditure in the process. So, they are hiring medical billers and coders who can work independently for them.
Role of medical billers for booking appointments
The medical billers and coders provide services to the physicians, medical billing companies, and the patients. They check whether all the appointments are actually billed. The doctors access the medical history of the patients, diagnose their problems and recommend suitable treatment for the patients. So, the medical billers check the following aspects
- If the appointments are actually billed.
- The invoices should reach the insurance companies.
- The claims should be settled by them. They should preferably pay the entire amount as instructed by the hospitals.
- If the amount is denied by insurance companies, then how would they handle?
- The patients should get maximum reimbursement.
- Are the insurance companies forwarding the payment at the earliest?
- The EOB’s also should be analyzed
Verifying records of the patients
Besides, they check whether the medical billing process is in the right track. They determine the realizable account receivable. They should match the appointments along with the amount settled. All the transactions should be entered into the accounting software. They should also track the rejection by the clearing house. The AR team should be incentivized and they should maintain a track of the calls made. The claims should be tracked at every stage and should be accessed if they are pending with the provider practice. The payer rejections should be handled carefully.
They provide physician credentialing and enrollment services to the physicians. They verify the insurance eligibility benefits of the patients. Then, the medical billers and coders access the demographics and claim charges of the patients and make the proper CPT and ICD diagnosis codes and check if they correspond with the AMA codes. The procedure codes that are provided to the client should be the part of CCI edit. Every file of the patient should be authorized. The claims should be settled in the clearing house.
The insurance payment should be made to the clearing house. If the entire amount is not paid, then the medical biller should negotiate with the hospitals and inform the patients. They also provide the healthcare creditionaling services so that the hospitals are paid on time. They should file the claims whenever necessary. They also provide the tertiary and secondary claim submission whenever required. They should be always updated with the local and state regulations.