Medical billing insurance process claim begins with a health care provider treating a patient and then sending the bill of services provided to the health insurance firm. The the insurance company then assesses the claims based on some factors to determine what claims to cater for if there is any. 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 typically use software to record patient data, prepare claims, and hand them to the right party.
Medical insurance claims can be delivered to the payer using either the manual or electronic method. Majority of insurance firms and healthcare providers prefer the use of the electronic request system. The electronic claims system is more accurate, faster, and cheaper to process.
Claims – Getting Started & Next Steps
Filing Insurance Claims Electronically
There are some technologies that have been introduced into the system so as to expedite application processing and increase accuracy. These are the following.
Looking On The Bright Side of Processing
When electrically entering information into the UB-04 and CMS-1500, some medical practitioners use software. The chances of having unreadable information is reduced by using the fill and print software. This the software may also include specific tools that can check for any errors in the document. While these tools reduce the errors in the reports, they are not completely accurate, therefore the medical biller should be diligent when filing out the forms using the software.
Medical Character Recognition (OCR)
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. While the OCR technology helps in making the processing of the hardcopy claims more efficient, human control is required to ensure accuracy.
Advantages of Electronic Medical Bill Claims
It is possible to integrate information between the hospital system and the insurer system.
The time of insurance reimbursement is minimized.
The the system allows saving of more patient related electronic data than when using the manual records.
Customized patient personal and medical data: location, insurance policy and insurance company details, medical history, tests, diagnosis, and other important information.
It lessens the number of errors as compared to the manual medical billing application.
Several medical billing clearinghouses use electronic methods in filing the medical claims. 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 companies may have their own submission rules which the hospital may not be aware of and thus the reason why clearinghouses come in handy.