Medical Billing and Collection Services

The healthcare industry is dependent on billing specialists for its smooth functioning to maintain a continuous revenue cycle. Billing specialists in the medical industry help in the optimization of medical billing. The process of medical billing and collection is a cycle of information sharing, payment, and reimbursement. This cycle consists of the patient (first-party), healthcare provider (second party), and insurance company/payer (third party). The second party referring to a healthcare provider is an umbrella term that includes hospitals, surgeons, physical therapists, emergency rooms, physicians, outpatient facilities, lab tests, and any other medical procedures or services that are being offered to the patient. It is the medical biller’s responsibility to gather all the necessary information from each party and negotiate the payment.

The aim of the medical billing and collections services offered by a medical biller is to make sure that the healthcare provider is duly compensated for his/her medical assistance. It is, therefore, the process of medical billing is carefully designed to gather the correct information. The steps followed by the medical biller to complete the process without any discrepancy are as follows:

  • Eligibility and Verification: This step requires a medical billing and collection company to contact the third party or insurance company to determine the eligibility of the patient for the medical services. After verifying the patient’s eligibility for insurance, the healthcare provider bills the patient as per the medical benefits.
  • Medical Coding: It plays an essential role in maintaining a patient's records from gathering critical information to streamlining medical data (including medical service, billing, and claims). The purpose of medical coding is to provide flawless assistance to both patient and healthcare provider for better returns.
  • Charge Entry: The charge entry team is responsible for providing reimbursements to the healthcare provider without any delay. This step determines the amount that the healthcare provider will receive from the third-party refund.
  • Claims Submission: Here, the purpose is to file an insurance claim without any interruption. Billing companies can make this process relatively easy and straightforward, for they have access to all the necessary information for insurance companies.

In addition to the above, a complete number of services are offered in the following disciplines to make the procedure quick and hassle-free.

  • Charge Posting: A team of experts is dedicated to review and post charges for every procedure. This ensures accuracy while eliminating incomplete and incorrect claims.
  • A/R Follow up: Payments from the patient and payer to the healthcare provider is term as accounts receivable or AR. A team is dedicated to A/R follow up so that the organization gets the money without any delay or fraud.
  • Credit Balance: The term refers to an increase in payments/adjustments beyond the posted changes. Such an increase in costs is indicative of financial issues that may affect the provider and needs to be resolved immediately.