Settling payments with regards to insurance for healthcare services can be a strenuous task for hospitals and clinics. Especially if you just recently started your practice, you would think that you would see your patients and their treatment and that would be it, and then you’re stuck with figuring out medical bills at the end of the day. To make your practice more successful, and your patients feel more satisfied, you want to give them proper attention, so they feel comfortable. This will also improve the relationship of the patient with the health provider and will improve cash inflows in the long run. So, what steps are healthcare providers taking to improve the services?
In the U.S, after treating the patient, the health care provider has to follow up on the health insurance companies regarding the settlement of the treatment offered to the patient. This includes charges of various procedures that may be included in the patient’s treatment process. Most healthcare providers prefer outsourcing the medical billing procedure to experienced companies, leaving them to handle all the related matters. In order to make this procedure as simple as possible, medical billing services companies use a process that minimizes the majority of difficulties faced by healthcare providers in operation.
When a new patient calls to visit the doctor, their information is automatically registered, while existing patients’ information already exists in the database, so they will just need to explain the reason for visiting. This will also decide whether they are viable to receive treatment from the provider.
When the patient’s first calls to visit the doctor, information is noted, and it can be used to determine what treatments are covered by the patient’s insurance, then the patient can be informed about it.
Many insurance companies have different policies regarding the cost of treatments they cover so the healthcare provider must discuss those treatments with the patient. If the provider sees that the treatment is not covered by the insurance and the rest of the payment has to be covered by the patient himself, then he should inform the patient beforehand.
This involves asking the walk-in patient to fill out some forms and using a valid identification document such as a license etc., to validate the insurance card.
As for the checkout patients, the medical quarter receives the report from the current patients with it and translates everything into medical code through a specific procedure. This document then contains the patient’s medical history and is known as a ‘superbill’. Once this is made, it can be transferred to the medical biller.
Superbills are then turned into paper form by the medical coder, and they will include the cost that has to be paid by the patient. After the production of the medical compliance, the person who made it is responsible for making sure that it meets the requirement for compliance.
All claims are to be submitted electronically; manual claims can include less efficiency and a lot of mistakes; hence they are not preferred by authorities. Doing things electronically saves a lot of time, money, and work.
After the pair receives a claim, the process of adjudication begins. This is the stage where it is decided whether the claim may be rejected, denied, or accepted. The payer can analyze whether it is valid corresponding to the treatment received. These types are to be differentiated as:
After the adjudication process, the biller should receive a report from the payer saying the amount of claim they want to pay and the reason for doing so.
Following this, the patient will receive the statement which has the payment for the treatment availed. After the payer pays the agreed amount, the rest of the payment has to be cleared by the patient.
In the final stage, it is made sure that all the bills are cleared, and the billers do their job of mailing out and following up with patients whose bills are outstanding. For the patients who clear their dues, the information is stored in their files. For those who did not yet, they are contacted by the provider and followed up on until they have cleared the dues.
It is important to be fully aware of the healthcare providers’ regulations and policies before performing these transactions, as every provider has varying rules and guidelines.
With the advent of technology and advancements, medical billing companies have been continually progressing towards making the healthcare system better than before. The more their services are efficient the more they reap profits. We hope this was an informative post for you. For more exciting reads, do explore our website.