Nearly everyone wishes to live a happy and healthy life, but there are times when a person falls sick to some illness or gets injured. The most essential thing people need in times of difficulty, such as illness or injury, is financial support that could cover the medical expenses.
Health insurance is a valuable type of insurance plan that covers or pays for the medical or surgical expenses, prescription drugs, and some dental expenses incurred by the insured person. People with health insurance are called ‘insured or subscribers’ and pay a certain amount of money, which saves them from medical expenses.
Importance of Healthcare System:
The Healthcare system is an essential component of medical business in a society and includes the provision of broad range of services to people of all ages. The healthcare system ensures that the medical services are met according to the condition and demands of the patients. In recent times, there have been numerous changes in the medical field, and the healthcare system must adapt technological advancement to properly look after the patients and ensure proper treatment is carried out.
As the population grows, the importance of the healthcare system intensifies particularly in times of any global pandemic like one caused by Coronavirus, which has put tremendous pressure on the capacity and capability of health institutions and healthcare providers. There has been rapid integration of innovation and technology in the healthcare system to ensure the physical and mental health being of people.
Types of Healthcare:
The healthcare billing companies play a vital role in the healthcare system that is divided into three categories that are primary care, secondary care, and tertiary care.
- In Primary care, the healthcare provider serves as the first contact and provide day to day healthcare to patients
- In Secondary care, the primary healthcare physician may refer the patient to a specialist doctor or surgeon who has more knowledge on the patient’s symptoms and health condition.
- In Tertiary care, the patient is referred by both the primary and secondary healthcare providers to a bigger medical center that has advanced facilities.
What is the role of Medical Billing and Coding in the Healthcare System?
In the US, healthcare providers receive certain compensation for delivering medical services in the best of manners to the patients, the medical services includes diagnosing, evaluating, and treating patients.
Medical Billing is a term used to denote the process in which the health practitioners such as the doctors and nurses fill forms according to medical services rendered to the patients so that claims can be submitted to the insurance companies and payments may be received. Medical billing is a process that converts the healthcare service into a billing claim.
Medical coding, on the other hand, is a process where medical services, equipment, diagnosis, and medical procedures are converted into universal alphanumeric codes. A clinical coder is a qualified and certified professional who analyzes the medical and clinical statements and assign codes according to a given classification system.
Both medical billing and coding are considered the backbone of the healthcare revenue cycle that ensures that the healthcare provides are timely compensated for the medical and clinical services they provide to the patients. Codes help in accurate and efficient billing.
The procedure and diagnosis are used to the effectiveness of a medical procedure or to track the spread of the disease. But the main purpose of medical billing and coding companies in Georgia is for reimbursement to the healthcare providers.
Why Medical Bill is Significant:
When a person is ill, going to a doctor may seem like only one interaction between a patient and doctor, but it is part of a large network of information, rendering of medical services and payments. The complete medical diagnosis and treatment is a three-way process that includes
- Patient
- Healthcare Provider (includes hospitals, clinics, physicians, emergency rooms, physical therapists, and outpatient facilities)
- Insurance Company or payer
The role of the medical biller is to discuss and arrange proper payment between the three parties. The biller ensures that Healthcare providers are compensated correctly for their services. The biller collects the information about the patient and medical procedure from the ‘superbill,’ then that information is compiled in the form of a bill for the insurance company, which is called a ‘claim.’ The claim contains the patient’s
- Medical history
- Demographic information
- Insurance coverage: and
- What medical procedures (procedure codes) or services were rendered and why (diagnosis codes)
There are different types of health insurance, where some procedures and services are covered, and some are not. It is the job of the medical biller to interpret the patient’s insurance plan or coverage and use the information to prepare an accurate claim. A medical biller uses both procedure and diagnosis codes presented by medical coders to make a claim.
- Procedure codes are CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, and it tells the ‘payer’ what service was provided
- Diagnosis codes are ICD (International Classification of Diseases) codes that show medical necessity.
The medical biller also ensures that the claim is compliant, which means that information is factually correct. If the claim is approved, it is sent back to the biller with the amount that the payer will pay. The biller then takes the balance and sends it to the patient.
Reasons for Professional Medical Billing Services:
The seamless provision of medical services is not easy as the healthcare providers have to not only administer the appropriate care to the patients but perform the administrative tasks as well. Medical billing consumes valuable time, which can be used to resolve more pressing issues. The process of finding and training the right candidates to manage the billing and coding task can also be time-consuming and challenging. Also, if the claims are wrongly processed, then it can put a negative image on the medical practice.
Traditionally, most medical practices such as hospitals, clinics, and other medical institutions used to take care of billing through paper and files, but now most of the claim submissions and transactions are made through electronic means.
The cost-effective solution for most healthcare providers is employing third party professional medical billing firms that can perform effective claims management. Pettigrew Insurance is one of the finest and dependable company that provides medical billing and consulting services and efficiently process, submits, and do follow-ups on insurance claims to save the medical staff’s time.
The medical billing software companies employ a qualified and skilled team who are familiar with the specific payers and can work diligently, knowing about a company’s particular policies to get payment in minimum time. The billing company can also perform follow-ups on refused claims and pursue delinquent bills. The advantages of employing medical billing companies are
- Improved and fast workflow without overburdening the medical staff
- No confusion when dealing with particular and specific payer’s payment policies
- Reduction in claim processing and submission errors
- Extensive follow-ups are done to ensure that providers are reimbursed swiftly
- The claims are processed at a faster rate, and even rejected claims are pursued
- Streamlines the entire revenue cycle of healthcare management
- Patient satisfaction improves significantly when claims are processed timely and quickly
- Per patient cost is considerably reduced
- All clients are given designated account, and a representative is assigned who is familiar with the specific medical practice.
One of the best advantages of medical billing and consulting solutions is that the complications in steps of claims submission and billings are reduced, and the stress levels of the staff are lessened.
You can find more information on medical billing and its advantages Here.
The cost of billing and coding services varies between companies, but it is mostly determined on the setup fee, the total number of claims submitted, a monthly fee, and a collection fee. Today, nearly every medical practice uses some sort of management software solution that can keep track of patients, schedule appointments, and store key medical information. In the fast-paced medical environment, the medical billing conference or solution are helping with a smooth flow of the healthcare revenue cycle and timely delivery of quality healthcare to patients.