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Medical Billing

eClaim Solution > Medical Billing

Medical Billing Services:

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An efficient and robust healthcare system is based on a few key elements that include the various health providers, the administrative staff, medical equipment and machines, medicines and drugs used for the treatment of diseases, and insurance companies. Medical billing Services need proper financial resources to ensure not only the delivery of medical services to the patients but payment to the health providers and support staff, and also payment of overheads.

The Significance of Revenue Cycle in Medical Billing:

  • Revenue Cycle Management is essential to streamline the tasks and allow the medical practice to run smoothly.
  • Sophisticated management software is needed to automate key functions such as scheduling, medical billing, and coding claim submission to insurance companies, and collection of payments.
  • One small mistake in entering the right patient details or assigning incorrect codes can disturb the revenue flow of medical practice.
  • Most people buy health insurance, which allows them to cover the expensive medical bills, which can be tough for anyone who is going through financial constraints.
  • Health insurance companies offer different plans according to the type of disease and the estimated amount that will be served on the treatment.

The 10 Key Steps for Successful Medical Billing:

Patient Check-In or Registration:

The first and foremost step is to note down the patient’s details, such as his/her age, gender, address, and phone number. The insurance-related information is key and also taken down which includes

  • Insurance plan
  • Policy ID or number
  • Name of insurance payer
Insurance Verification:

An insurance plan, and coverage status can change anytime, so the patients have to verify their insurance information and eligibility every time they visit the medical practice. The healthcare provider should ask and double-check for the insurance plan and coverage as it can have a direct impact on the claim processing and resulting reimbursement.

Patient-Provider Meeting:

The provider evaluates the information and takes the decision on the appropriate treatment by listening to the patient’s symptoms and medical problems.

Medical Transcription:

A qualified and experienced professional will listen and see the recording to correctly document the patient information in a medical script, which is later used to maintain and update if the patient comes again for a visit. This step should be error-free as the information is used for correct treatment and follow-ups. Any error can lead to claim rejection as the medical script is also used for billing services.

Medical Coding:

eClaim Solution has specified certain guidelines that a professional coder uses to convert the medical information into alpha-numeric codes. The information includes

  • The reason for the visit
  • The type of diseases diagnosed
Charge Entry:

The first step in preparing the claim form that is submitted to the insurance company is the expenses incurred to render the service is added to the amount that is calculated by the medical coder. Without a definite or accurate amount the payment cannot be collected. The claim form should be completely checked to insure the right amount as it results in reduced payment or claim rejection. The medical claim forms mostly provide

  • Patient Information
  • Patient’s medical history
  • Procedures provided with correct codes
  • Place of service code
Claims Submission:

When the patient information, health provider information, and service provided are added to the claim form then the claim is set to go, and will be submitted to the insurance company for reimbursement.

  • Electronic Health Record (EHR) software checks if the relevant fields in the claim form are filled or not and the corresponding coding.
  • The given patient information is verified by third-party EDI vendors such as name, Date of Birth (DOB), name of the policy, and possible coding errors
  • The insurance company also verifies the patient information, sees the policy and action, and check for coding errors. If there are any differences in the claim form, then the claims are returned to the health providers as rejected.
Claim Denial Management:

Only those claims are processed by the insurance company that are received within a specific time limit. When the claim is accepted then some checks are made, sometimes the claim is paid in full, and sometimes a part of the claim is paid, and the rest of the charges are denied. The medical practice has a team that reviews the claim and resends it to recover the denied charges and ensure full revenue is generated.

Accounts Receivables:

The claims denied even after corrections are followed rigorously with the insurance company, and further information is gathered that causes a denial of payment. The Insurance Coding, Medical Coding, and Charge Posting are shared to see for any errors.

Payment Collection:

Once all the checks are done, and the insurance company decides to pay the claim, then either a paper check or electronic fund transfer is made. Bulk payments are sent along with a summary called Explanation of Benefits (EOB). The professional team at a medical practice is responsible for posting entries in the EHR software is made by the professional team at the medical practice.