The Process of Medical Billing Insurance Claims The the process of medical billing insurance claims starts with the healthcare provider treating a patient and then sending a bill of services offered to a health insurance company. The insurer then evaluates the claims based on several factors and determines which, if any services they will reimburse. There are several technical rules and work standards that must be fulfilled for insurance claims to be delivered conveniently and accurately between medical practitioner and the payer. Medical billing specialists use some software to take the patient data, prepare insurance claims, and hand them over to the appropriate party. Medical insurance claims can be delivered to the payer using either the manual or electronic method. Most healthcare providers and insurance companies prefer the electronic claim system. This system is faster, cheaper, and more accurate.
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Electronic Claims Filing There are some technologies that have been introduced into the system so as to expedite application processing and increase accuracy. They include the following.
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Software Some healthcare providers use software to feed information to the CMS-1500 and UB-04 documents electronically. The fill and print software prevents the possibility for unreadable information. The software also may include certain tools that check for errors in the documents. While these devices decrease the occurrence of errors; they are not 100 percent accurate and hence the need for the medical biller to remain diligent when filling out forms using this software. The Medical Character Recognition OCR equipment is used to scan official records, electronically isolate and record information provided in the different fields and auto-filling that information into other documents when needed. The OCR technology helps make hard copy claim processing more efficient, but human oversight is still needed to ensure accuracy. Advantages of Electronic Medical Bill Claims Integration of the insurance company and hospital system is possible. The time of insurance reimbursement is minimized. Saves more numbers of patient related electronic data than manual records. Customized patient personal and medical data: location, insurance policy and insurance company details, medical history, tests, diagnosis, and other important information. fewer errors in insurance claims than when using manual billing. There are several medical billing clearinghouses using electronic medical billing claims systems. Clearinghouses serve as a bridge between the insurance carrier and the hospital. The clearing houses receive claims from the hospital, remove any errors from them, put it in the recommended format, then submit it to the relevant parties. The clearinghouse is quite important because the healthcare provider is required to submit insurance claims that are of high quality at various insurance companies each day. Each of these insurance providers have varying submission criteria which the hospital might not be familiar with and only the clearinghouse can deal with that.