An In-Depth Look At Medical Billing Services
Outsourcing medical billing services can save your practice a lot of money, headaches, and time. When you outsource medical billing services, you can breathe easier and sleep better at night, knowing your revenue cycle will be maximized and your bills taken care of. The benefits of medical billing services cannot be overstated; however, most physicians, hospitals, orthopedic surgeons, oncologists, and free standing emergency service centers understand the freeing nature outsourcing medical billing services brings.
Comprehensive Healthcare Revenue Management (CHRM) is the best medical billing and coding provider. We specialize in helping physicians, including orthopedic surgeons and oncologists, by taking the medical billing burden from their shoulders. Here, we’ll take a hard look at the medical billing process from start to finish, from the moment the patient makes an appointment to the moment your practice receives payment. Call us for all your medical billing services today!
WHAT IS THE JOB OF THE MEDICAL BILLER?
A medical biller is a specialist who is trained to code and bill medical services offered by physicians, hospitals, free standing emergency service centers, and specialists, such as orthopedic surgeons and oncologists. Medical billers are specifically trained to:
- Understand what service was offered by the physician or hospital and code it properly.
- Bill accordingly based on insurance information gathered by the practice or hospital.
- Receive and process all payments, as well as resolve any denials or rejections.
Of course, this is simplifying the medical billing and coding process. However, this is what medical billing services do in a nutshell.
SCHEDULING AN APPOINTMENT AND PATIENT ARRIVAL
When a patient calls in for a doctor’s appointment, basic information is collected over the phone, from personal information, such as name, birthdate, and address, to insurance information, such as the name of their healthcare provider and the policy number. All of these elements are crucial because if there is one transposed number, such as a birthdate entered wrong or the wrong letter or number entered from the policy number, odds are, the payment process from the medical billing service will be delayed.
This first step in the medical billing process that is handled by the physician’s office is often a place where errors are made. It is important to emphasize to a doctor’s front office staff the importance of double checking their work. We all make mistakes; it’s correcting these mistakes before the medical billing and coding process really gets going that can save money in the long run and maximize the revenue management cycle process. Review all forms and information in the computer before the doctor’s visit even begins.
DETERMINING INSURANCE COVERAGE
Determining fiscal responsibility is a very difficult process for front office staff in an orthopedic practice, for example. Everyone’s policies are different as well as the individual providers themselves. The front office staff is mostly responsible for determining which services are covered, what amount will be covered, and thus what amount the patient will owe before they leave the doctor’s office.
This step is crucial in the medical billing services process. For example, some procedures are only covered in certain instances, like bloodwork if a suspicious lump arises. Furthermore, some procedures, such as certain elective surgeries, are also not covered at all. These out-of-pocket expenses must be collected, preferably before service, in order to minimize these medical billing services losses.
In addition, some insurance companies and policies have certain protocols they must follow, such as obtaining preauthorization for certain medical procedures. These processes must be followed in order for the doctor’s appointment to go smoothly for all parties involved. Furthermore, this yields less headaches for your medical billing service.
Once all means of payment have been verified, it’s important to divulge this information to the patient so he or she can be prepared for out-of-pocket expenses. Many health insurance policies have co-pays, which is usually collected ahead of time before medical services are rendered. When all parties are on the same page (provider, patient, and insurance company), it makes the medical billing and coding process easier.
AFTER THE MEDICAL BILLING SERVICE
All medical billing services are accounted for after the patient’s visit. In addition to the patient’s medical record, these medical services are recorded for medical billing accuracy. One thing to note is that this is often a place where errors can occur that then translate into medical billing and coding errors. Emphasize to your front office staff the importance of recording accurately the medical services that were rendered. This information is then sent on to the medical billing services team, such as Comprehensive Healthcare Revenue Management.
Here is where the heart of the medical billing and coding process (as well as the reason why you hire a professional medical billing service) lies. Once the medical services have been received by the medical billing service team, the magic happens (or at least we think so). Your medical billing service team will code all diagnoses and medical procedures performed during the patient’s office visit. These codes are universal (called the Current Procedural Terminology, or CPT or the ICD-10, which is used for diseases and abnormal findings) in order to streamline the medical billing process and ensure accuracy in compensation for the hundreds of medical procedures performed.
Finally! A medical billing service bill. After the medical coding, a medical billing service bill is produced in what is called the patient ledger. The patient ledger is a record of any previous outstanding charges that have yet to be paid either by the insurance company or by the patient themselves, which provides the patient a current balance owed. Either the patient can pay this portion now or many medical practices, such as orthopedic surgeons or oncologists, allow their patient’s to carry balances or set up a payment system.
MEDICAL CODING AND BILLING SERVICES COMPLIANCE
Now that the patient has their bill clarified and their portion paid, it’s almost time to process the bill through an electronic processing system that in effect “mails” the bill to the insurance company for payment. However, before that can occur, certain requirements must be met that are set by HIPPA (Health Insurance Portability and Accountability Act), and the Office of Inspector General (OIG). These can vary based on medical services rendered, but in general, it’s to ensure protection of patient information.
Furthermore, this is where the medical billing service ensures all the fees charged to the patient are accurate, which can be challenging since different medical practices charge differently for medical services. This, again, is magic by the medical billing service since this is a lot of information to get right.
In addition, the codes must be compliant with the insurance company. After all, it’s important to speak the same language and each insurance company has their own rules to determine which medical billing services can and cannot be billed for. Again, this is magic, because if the language is wrong, the bill be denied and returned to the physician’s office, resulting in a delay in the medical revenue cycle. These delays can be costly to both the medical billing service and the physician. Errors take time to correct and add a layer to an already deep strata of earth.
SENDING THE MEDICAL BILLING CLAIM
Once all medical procedures have been diagnosed, coded, processed, and the compliance issues verified, the medical billing service then processes, or send, off the medical bill to the insurance company for payment. As long as all the i’s are dotted and the t’s are crossed, this bill should provide the insurance company with all that they need to understand what medical services were rendered and what the charges were. This ensures a timely processing of payment by the insurance company and no delay in the revenue cycle management, which, of course, is the main reason you hired a professional medical billing service, such as CHRM.
Most medical billing services submit claims electronically. This is the easier and more efficient way to process payment. When the new medical billing codes were instituted recently, the ICD-10 changes emphasized codes that were easier to be processed electronically. Submitting claims electronically reduces medical billing errors, speeds up the collection process exponentially, and eliminates a bunch of manual data entry. Overall, this saves the medical community thousands of dollars.
However, there are many different medical billing service software programs that must be learned and mastered. Medical billing errors can still occur, and it’s important for your medical billing service to not become lackadaisical in their coding and processing procedures. Keeping up with the software is important and on-going training is prudent in order to maximize the savings from processing claims electronically.
Some medical billers will use a clearinghouse before submitting their medical billing services to the insurance company. A clearinghouse is similar to a medical billing service except the sole purpose and job of a clearinghouse is to verify that the information you have coded is in line with the insurance company’s submission process. As we’ve mentioned, medical billing services usually provide this service, but this option does exist and some smaller medical billing services utilize a clearinghouse in this process known as scrubbing. Note, the clearinghouse just checks for errors; it doesn’t correct them. This is a key difference between a clearinghouse and a medical billing service. CHRM does use a clearinghouse for efficiency purposes.
PAYMENT FROM INSURANCE COMPANIES
Once the insurance company receives the properly formatted medical bill, either through your own service, a medical billing service, or a clearinghouse, the insurance company then puts the patient’s medical bill through a process known as adjudication. It is during this process that the insurance company decides what is covered, how much of the medical services it will cover (or all of the medical services), and how much is the patient’s responsibility. This is based on the patient’s insurance coverage and if there’s an existing contract between the provider (physician, hospital, free standing emergency room, orthopedic surgeon, oncologist, etc) and the insurance company.
Once the insurance company decides its portion, a report is sent to the medical billing service and/or the provider, detailing its decision. If there is still an outstanding amount due, the medical billing service will determine if there is another insurance coverage to bill for the patient first before sending a final bill to the patient. The medical billing service will make sure that the amount covered matches up with the reimbursed amount, which is usually predetermined between the provider and the insurance company. This is another important task a medical billing service offers.
The medical biller ensures that all procedures billed show up on the insurance’s list of services rendered so that none are forgotten. Payments are then matched up before billing the patient. If a discrepancy is found, an appeals process is started in order to ensure the maximum amount is received from the insurance company to the healthcare provider. It is these little details that can add up to thousands of dollars that the provider, such as the oncologist or orthopedic surgeon will miss out on, that a medical billing service becomes worth its weight in gold.
BILLING THE PATIENT
If everything is in aligned with the stars:
- Procedures and codes billed by the medical billing service match those received and processed by the insurance company
- All charges are in compliance order
- Healthcare provider had been reimbursed for services rendered
THEN, a final bill is sent to the patient. It is important to provide the patient with a breakdown of the charges and the dates the services were rendered, a breakdown of what insurance covered, and a breakdown of any payment already made (such as co-pays) so that the patient can understand where the final amount owed is coming from. This preempts calls from the patient, asking for their medical bill to be explained.
A due date is usually calculated based on when the insurance company paid, and once final payment has been received, it is recorded and the medical bill effectively closed out. This is the end of the medical billing services’ job. If a patient goes unpaid, the responsibility for payment falls on the healthcare provider’s shoulders, and if collection services are initiated, this as well is initiated by the healthcare provider. However, some medical billing companies (including Comprehensive Healthcare Revenue Management) will manage patient accounts, including patient’s late payments for up to 120 days until the healthcare provider decides to turn the bill over to collections. A medical billing service codes, bills, and works with insurance companies. We post payments from insurance companies and clients, as well as process any overpayments and refunds.
THE CHRM DIFFERENCE
This whole process must be intimately understood by your professional medical billing company, such as Comprehensive Healthcare Revenue Management. From patient check-in to final patient bill collection, this process is where an exceptional medical billing company shines. It takes stellar organizational skills, a commitment to following up whenever needed, a tenacity to track down denials and rejected claims, and an air of transparency so the healthcare provider knows exactly where he or she stands in their revenue cycle.
CHRM endeavors to offer the best medical billing services possible. By using modern technology to streamline the process and aid in communication on all sides, from the healthcare provider, the insurance provider, and the medical billing service, your revenue cycle can be maximized. Medical billing companies such as CHRM invest in their staff in on-going training in order to minimize errors, promote the efficient use of medical billing software, and keep up with changes in medical billing codes in order to deliver the best medical billing services to all of our clients, which include physicians, hospitals, free standing emergency centers, oncologists, orthopedic surgeons, and hospitals. We have special departments who specialize in certain types of medical billing services in order to further maximize efficiency and standards and minimize errors.
CHRM strives to be transparent in all of our medical billing services, meaning we don’t hide your data from you. In fact, we offer monthly reports so you can track your revenue streams and help you analyze where your weaknesses lie in terms of your revenue cycle. We are honest; we hold ourselves to a high standard; and we excel. We treat our clients how we want to be treated. We are available at any time to answer any questions your staff may have about anything, and we offer training as well.
We believe there’s not a better medical billing service. We exist to make your hospital, free standing emergency service, orthopedic or oncology practice easier. Contact us today to see the CHRM difference in your practice!