The medical billing insurance claims process starts when the health care provider treats a patient and sends the 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 some technical protocols and industry standards that must be met for the efficient and accurate delivery of insurance claims between the payer and medical practice.
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. 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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Some healthcare providers use software to enter information into the UB-04 electrically and CMS-1500 documents. The fill and print software prevents the possibility for unreadable information. The the software also includes tools for checking any mistakes in the report. 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.
OCR (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 using Electronic Medical Claims Service
Integration of the insurance company and hospital system is possible.
The time of insurance reimbursement is reduced.
Saves more numbers of patient related electronic data than manual records.
It allows for customized patient medical and personal data including their location, medical history, diagnosis, tests, insurance policy, insurance company details, and other relevant information.
fewer errors in insurance claims than when using manual billing.
There are numerous medical billing clearinghouses that use electronic means to file medical claims. Clearinghouses serve as a bridge between the insurance carrier and the hospital. What the clearinghouse does receive claims from the health care provider, remove any errors in them, and put it in the HIPAA and insurance standards format, and then send it to the appropriate parties.
The the clearinghouse is necessary because the healthcare provider is required to send high-quality insurance claims each day to many different insurance companies. 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.