What Functions Should a Medical Billing Service Perform?

Many health care providers are exploring the opportunity that lies in outsourcing medical billing functions. Medical billing has traditionally been done within the office. But as challenges such cuts in insurance reimbursements, time restraints and the bundling of billing procedures, providers are opting to use medical billing services.

Functions performed by a medical billing service

When selecting the most suitable medical billing service to take over medical billing, it’s inherent to know what functions the service provides. In general, the service must aid in performing the following processes: Generation and submission of claims; Carrier follow-up; Posting and processing of payments; Patient invoicing; and, Collection of agency transfer fees.

It’s undeniable that medical billing is a large and complicated process. Using a medical billing service helps to ensure that the above processes are carried out properly.

Here are some of the functions your medical billing service could offer:

i. Registering patients: Probably the most frequently needed function, registering patients deals with collecting personal health and insurance details of a patient to ensure that you offer every patient with the services they need and for which they are eligible.

ii. Confirmation of financial responsibility: Who owes you what for certain doctor’s visits? With pertinent information about a patient, the service is able to determine the amounts expected from different insurance providers.

iii. Patient check-in and check-out: These are rather straight-forward procedures but if not done well the company’s efficiency and profits could significantly suffer.

iv. Claims preparation + checking compliance: The biller gets the superbill from the coder and puts it into the practice or billing software, or into the proper paper claim form. The biller also makes sure that the claim satisfies the compliance standards, both for format and coding.

v. Claims transmission: Electronic submission of claims is the new order of doing things. A medical billing service will ensure that all claims are transmitted the right way and that the appropriate standards governing the procedure are observed.

vi. Monitoring claims adjudication: Adjudication is the process through which a medical claim is evaluated and it is determined whether it is compliant/valid or otherwise. A medical biller will help to monitor the process so that the claim is processed within the arrangement rules and that the eligible patients find help.

vii. Generating patient statements: Upon receiving a report about the claim from the payer, the billing service makes a statement for the customer. This is the bill for any procedure(s) the customer received from the medical services company.

viii. Following up on payments and handling collections from patients: It’s the duty of the medical billing service to ensure that all medical bills are well paid. They mail out timely, accurate bills and then follow up with patients with delinquent bills.

Why do you need a medical billing service?

The above functions are the “heart” of medical billing. Medical billing services like Open Practice excel in these functions. They help you to increase the efficiency of your practice. You are able to focus more on your patients and there is a considerable improvement in claims’ accuracy. An additional benefit is that your company can use the expertise of billing specialists. Ultimately, the company’s revenue and profit will increase.

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