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Hospitals across America deal with over a thousand insurers daily, each having its individual requirements & plans. As a result, hospitals have the difficult task of providing the finest treatment available to the public while still satisfying income generation requirements.
Healthcare claims are generated to bill payers for the healthcare services rendered by medical providers & hospitals, including both outpatient & in-patient services.
The payers are also billed for the medical facilities provided such as laboratory tests & usage of special medical equipment.
An efficient hospital billing process boosts a hospital’s healthcare revenue cycle by ensuring that all necessary claims are billed.
The hospital billing process starts from the moment a patient schedules an appointment with your hospital. After scheduling an appointment, the patient must register with your hospital.
If a patient comes to your hospital for the first time, your administrative personnel will gather their demographic information. If the patient has already visited your hospital, you most certainly have the demographic information. After following confirmation that a patient's information is on file, the patient will indicate the purpose of their visit, which is then documented by your staff.
Upon receiving a patient’s insurance information, a medical biller determines the healthcare services that are covered by the patient’s insurance plan. Insurance coverage varies from person to person depending on their plan and insurance provider. It is imperative for the biller to confirm every patient’s insurance coverage for billing them appropriately.
If any services are not covered by the patient’s insurance provider, it is vital that the patient is aware of any charges they will have to incur.
When a patient arrives at a hospital the front desk asks them to fill out a few forms to collect personal and insurance information. They are required to provide proof of identity, such as their insurance cards and driver's license. This is known as the check-in procedure.
When a patient checks out of the facility, their medical report from that visit is forwarded to a medical coder. The coder analyzes & reviews clinical documents to translate the services delivered into a diagnosis and billable procedure code. A superbill is prepared and subsequently delivered to the medical biller. This is known as the check-out procedure.
Upon a patient's check-out, the medical biller takes the superbill and prepares a claim that includes the patient and provider's information, the description of the services provided, & the amount to be paid by the payer.
After creating a claim, the medical biller must ensure that it meets all basic requirements and standards of billing compliance as laid out by the Health Insurance Portability and Accountability Act (HIPAA).
After making sure that the claims created meet the necessary compliance standards, medical billers submit their claims to the payer or a clearinghouse.
The insurance payer evaluates and reviews the claim to ensure its compliance. Whether the claim will be approved or denied is based on this. An accepted claim is paid by the payer, whereas a denied claim is refused. This claim should be then revised and resubmitted for reimbursement.
If a claim is approved, the payer will decide how much of the claim's cost will be refunded. Following this, the medical biller will receive a report outlining, that how much of the claim they will cover. It may also include an explanation for why a particular claim was refused.
A statement for the patient is generated which details the services that have been covered by their insurance provider & the portion of the cost that the patient is required to pay.
The medical biller must ensure that the patient pays for the treatments which their insurance company did not cover. If a patient fails to pay the remaining balance by the due date, the case may be turned over to a collection agency.
We are a HIPAA-compliant hospital billing company. We follow all HIPAA regulations, including superior documentation, well-defined processes, and regular audits.
Frequent training keeps our coders up to date on the continuously changing guidelines of regulatory authorities and other insurance payers.
We conduct routine claims audits to identify faults in existing systems and eliminate them to guarantee full reimbursements.
We ensure excellent accuracy levels through a multi-level quality check process for each essential component of hospital billing.
To ensure continuous cash flow, we rely on excellent technology such as Athena, Brightree, WebPT, and AdvancedMD to expedite hospital billing operations.