Medical Transcription

Medical billing services include those companies which will carry out the processes for claims made by healthcare providers to insurance companies. Their role is to submit and then follow up on the claims made to ensure that the healthcare provider is paid for the work that they have completed. It does not matter whether the insurance company is privately or government owned, as the processes used by a medical billing service are exactly the same for both.

So just what is the billing process?

The first step in the process is for the patient to visit the healthcare provider (doctor). Then, after the appointment, the doctor or other medical professional will update their patient's medical records. Then they will provide to either the billing service or a medical coder a particular code that they then use to bill the insurance company. Upon receipt of this code, a billing record is then produced (it can either be in paper or electronic format). Plus, each bill will also include details relating to the various diagnoses provided by the doctor, and for each one of these a code will be provided and all these codes can be found in the ICD-9 Manual.

Once the bill has been prepared, it can now be submitted to either a clearing house (which will act as an intermediary for the insurance company) or directly to the insurance company instead. If a clearing house is used, they will edit any claim as per the rules provided by the insurance company (those that are going to be paying the bills). However, if these bills do not meet the criteria provided by the payer (insurance company) then it will be returned to the user. They will then be required to make alterations to them and resend them. This not only saves time but will prevent any complications occurring later on.

However, if the medical bill is sent directly through to the insurance company, they will then process the claim. But the first thing that they do is test the claim to see if it is valid or not. The tests that they carry out will look to see if the patient is eligible for their bills to be paid, look at the credentials of the doctor or healthcare professional and whether the treatment is a medical necessity. If these tests are passed successfully then the insurance company will pay the bill provided to them by the medical billing services. However, if it fails any of the tests then the claim will be rejected and a message will then be transmitted to the medical billing service informing them of this decision. Once the claim is returned, then corrections can be made where required and it can then be resubmitted. Sometimes a claim submitted by a medical billing service may well be resubmitted several times before it is actually accepted or the claim is paid in full.

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