Hospital Billing Collection

Hospital Billing and Collection Services

The USA is home to numerous hospitals and healthcare providers who are committed to providing sound healthcare services to the people of the country round the year. A big part of what keeps them going is payment which the sooner they get the better as any delays can affect their functioning both in short and long term. Almost everyone in the USA is covered by health insurance but with more than 1600 insurers and with each of them having a different plan hospital billing and collection becomes a complex thing to do. Moreover, one also has to adhere to the existing government rules and regulations in place when filing the bills that can be processed easily. This is why the healthcare industry employs numerous billing service providers and specialists who help with consistent revenue cycle management.

Hospital Billing and Collection includes gathering patient information, filing claims in the right manner, follow ups and reimbursement. Three parties included in this are the patient (first party), healthcare provider (second party) and insurance company/payer (third party). Specifically for hospital billing and collection the second party has to be a hospital wherein service can be provided by anyone who works for the hospitals be it general physicians, surgeons, nurses, physical therapists etc. It is the duty of the Hospital billing and collection service provider to gather the information from all the parties and negotiate the payment. This is in agreement with their ultimate objective of ensuring that the hospital is adequately compensated for the services offered.

The steps followed by the hospital biller and collector are:

  • Registration: Most hospitals require patients to pre-register especially if it is their first visit to the hospital wherein they have to give their personal as well as insurance information.
  • Eligibility and Verification: In order to perform this step, the hospital billing and collection company must contact the insurance company or third party to check the eligibility of the patient for medical services. After verifying the eligibility of the patient for insurance, the patient is billed after adjusting the medical benefits as per his policy.
  • Check in and Check out: While checking in the front desk pulls up the information the patient provided during pre-registration which if not provided is collected. During check out the medical report and bill is generated which is then sent to the hospital coder.
  • Hospital Coding: Hospital coding involves maintaining patient’s data as well as gathering information related to medical service received by the patients as well as their billing and claims. All of this translated in the billing code which is then passed on to the payer or insurance company. Hospital coding streamlines all the data that is easy to access by the patient and hospital both.
  • Claims Submission: This step involves submitting the claim to the insurance company in a straightforward manner. The claim must have all the medical services received by the patient as well as patient information. They must meet the billing compliance in place as well.
  • Charge Posting: A team of experts review and post the charges for every procedure to eliminate any incorrect or incomplete claims.
  • Adjudication: In this step the payer or insurance company evaluates the claim in order to accept, deny or reject it.
  • AR follow-up: The payments made by the insurance company as well as the patient are known as Accounts receivables (AR). This team ensures that the hospital gets the money without any delay or fraud.
  • Statement: This includes the final statement settled by the insurance provider which is sent to the hospital with the receipt given to the patient as well.

Hospital Billing and Collection Company

The trained professionals at Capline are well versed with the process of hospital billing and collection right from the initial registration to the final payment statement. We eliminate the day to day operational stress felt by hospitals so that they can concentrate solely on providing the best patient care.

Hospital Credentialing Services

Hospital Credentialing Service

Hospital credentialing is the process of verifying whether or not a provider is qualified to provide medical services. The hospital requires information from the provider about their education, training, experience, licensure, experience, insurance and background. After a provider has been verified through hospital credentialing, the provider gets the authority to practice medicine.


In the year 1951, the joint commission was formed to create the first ever accreditation standards manual which would formalize hospital quality standards. The commission asked hospitals to form credentialing committees which would conduct regular reviews and check physician competence. There were no rules per se to collect and verify this information but the documents required were the same for all.

Hospital Billing and Collection Company

The documents are verified through primary sources for cross checking records for consistency as well as background checks and sanction checks by the Office of Inspector General (OIG). This task is sometimes performed by the hospital office staff with hospitals also resorting to third party contractors who are credentials verification experts.

After the documents have been verified, the hospital sends the applicant’s files to the credentialing committee who may meet the applicant to further discuss their profile with the stakeholders. If the committee approves the application, they send the information to the Joint Commission.

Post Hospital Credentialing Services

Once the hospital has received approval from the Joint Committee for the hospital credentials of the physician in question, they can grant privileges to the physician to practice at the hospital. The privileges are categorized into three parts namely active or admitting privilege which allows the physician to admit patients in the hospital, courtesy privilege which allows physician to admit or treat patients as a consultant and surgical privilege which allows the physician to perform surgeries as an outpatient and in the operating room.

Hospital Credentialing Company

In order to keep providing high quality patient care experts need Hospital Credentialing. Nonetheless, it can be a very cumbersome and complicated process especially when done by someone who has no prior experience.

Capline provides you efficient hospital credentialing services that include primary source verification, continuous follow-ups as well as conducting background checks. Our trained personnel and advanced technology ensures that your patients are protected at all times as the credentialing process is carried out in a smooth and efficient manner.

Hospital Insurance Verification Services

Hospital Insurance Verification Service

Hospital insurance verification is the process of reviewing the actions taken after the claim has been settled. Almost everyone opts for medical insurance which is why it is extremely necessary to keep track of insurance claims. This is where hospital insurance verification companies step in as they help hospitals verify the insurance claim filed as well as with the final claims submission. The hospital insurance verification is carried out to ensure that there is no fraud committed on the part of both the insurance company as well as the hospital. It is the duty of every hospital insurance company to review the patient’s insurance eligibility for the plan he/she has applied for.

Below is a list of all the steps involved in the process of hospital insurance verification:

  • Patient Scheduling: This involves collecting all the data pertaining to the patient's schedule via email, text, phone, fax etc. Hospitals can also opt for self-scheduling to make the process more streamlined as it will organize all the data in one place and will be easy to access. Furthermore, it will boost productivity and revenue management by eliminating long waiting lists as patients will only be allowed to schedule their appointment when there is a free slot available.
  • Patient’s Record: Hospitals are required to store patient’s demographic data which is further divided into two categories namely medical history and patient identification. Medical history consists of previous medical issues and diagnoses whereas patient identification may include name, date of birth, phone number, address and email id. Apart from this any other information like father’s name, emergency contact number, family doctor, insurance company provider and family doctor can be included as additional information. The key benefit of patient enrolment is that it eliminates occurrences of false claims by clearly documenting patient identity.
  • Eligibility Verification: In this step the hospital insurance verification organization contacts the insurance carrier to cross check the insurance details provided by the patient. This helps them learn key things like active/inactive status, eligibility status as well as coverage status. After the eligibility has been verified, it is important to verify the insurance coverage benefits.
  • Authorization: This step is all about facilitating trust between the hospital and insurance company. Authorization is the process of getting a nod from an insurance company for the amount that hospital is asking for services provided. The insurance payer signs off on the claim as the final gesture.
  • Update Patient: It is important to update the patient about authorization of their claim. However, in case there is a change or you require any additional information, the patient must be contacted.
  • Update Hospital Billing System: It is essential to update the hospital billing system with the correct billing details for claims submission.
  • Claims Transmission: Hospital insurance verification companies help hospitals get their claims transmitted electronically over computer for seamless processing and payment.

Hospital Insurance Verification Company

Hospital Insurance claim reimbursement is quite a technical process with a series of steps that need to be performed in a systematic manner. Over the years Capline has helped hospitals with insurance verification and processes claims in an efficient manner. Our experts ensure that you get the amount for the services provided by eliminating instances of frauds and denials.

Our Specialties

We provide tailor made services for a range of medical fields for both hospitals and physicians. Our Specialties include:

Hospital Credentialing Company