All You Need To Know About Medical Claims Processing

Medical billing via outsourcing has proven to be the most effective and productive solution within revenue cycle management (RCM). The main challenge faced by most healthcare professionals is the loss of revenue due to unsettled claims. Not all providers can easily handle the billing process. Glitches like billing and coding errors, denial and rejected claims, staff attrition and absenteeism, hiring and training new coders and billers, and managing audit files for an untrained workforce is time consuming. If physicians spend too much time on these tasks, it will  affect their core responsibility, i.e. patient care. Hence outsourced revenue cycle management is the model adopted by many practices.

Don’t leave the daily work behind medical billing to amateurs.  The expertise of the team engaged on your billing and coding determines the standard of your claims. That, in turn, determines how well your claims will be reimbursed. Your billing partner should have multi-specialty coders certified by AAPC. Do check this team’s qualification and skill before you confer your business process to an outsourced medical billing team.

It does not matter if you are a replacement provider or a longtime healthcare practice: Providing additional attention to medical claim processing is one of the most critical means of improving clinic income.

Patient care is the key focus of physicians. So many are unfamiliar with the healthcare finance aspect of the industry and lack the experience to handle medical billing. Many experienced providers aren’t well-versed in claims processing either. Many of them lack the newest technology and software. Others need skilled professionals who understand new healthcare reforms. In either case, outsourcing medical claims and billing is the best option! Providers who understand how complex the medical claims processing and billing system is already know this, from experience!

When providers provide medical treatment, they get paid by sending out bills to insurance companies covering said medical services. There are many stages in between. Firstly, claims are prepared by assigning specific ICD (codes used for diagnoses) and CPT ( codes used for treatment) to the medical services provided to the patient. These claims contain important information like patient demographics and plan coverage details. Then the claims are submitted to the payors. The insurance companies evaluate each claim and reimburse accordingly.

Medical billing isn’t a "one size fits all" solution. Finding the correct partner who understands your practice, specialty and billing needs can be difficult. Make sure you find a trusted independent billing company that knows the industry and can optimize your reimbursements.