The medical billing process consists of an interaction between any healthcare provider (like a consultant physician) and the insurance company (payer). The health care provider could be a private or government hospital, institution, or an individual physician’s clinic. Medical billers have to bill for all the different treatments, diagnostic tests, processes/procedures, therapies, surgeries etc, so that the bill amount can be claimed from the insurance company. Where does the primary data for the bill come from? Well, it is the duty of the concerned doctor to maintain / update the patient record which must have all patient information, the nature of his illness, examination/ tests conducted, medication lists, diagnoses and suggested treatments.
Depending on the complexity of the case the level of service is first determined that is translated into a specific medical code. Only then it becomes fit enough for insurance claim. Hospitals and physicians use specific types of medical claim management software that is used to manage the different medical claims. Such claim management software must ideally have the following features.
Today there is very convenient software available in the market that can be used directly by the doctors for claiming all their bills with great ease. Doctors using claims management software can easily track and manage their entire claims and can get quicker reimbursements from the insurance companies. These claim management software that are managed from just a single screen may have these following features,
- Claim charges can be reviewed before posting
- One can view claims that are not yet billed
- View bills that have been rejected
- Access to diagnosis codes
- Access to procedure codes
- Utilize all relevant claim forms
- Can track the claim runs
- Get alerts for problems
- Electronic remittance
- Direct online transmission/payments
- Online claim reporting
- Daily submission of claims
- Annual updating of medical codes are done by vendor
One of the chief advantages of using good medical claim software is that all data and changes in the law etc can be incorporated / upgraded and one need not worry about becoming obsolete. The online code book also ensures that doctors always have access to the latest diagnosis codes and procedure codes.
The author of this article is Ricci Mathew of
OSI (
Outsource Strategies International), a US based company that offers services in
Medical Coding, Medical Billing and
Medical Transcription for clients across the US.
