Medical Billing Insurance Claims Process The the process of medical billing insurance claims starts with the healthcare provider treating a patient and then sending a bill of services offered to a health insurance company. The insurer then evaluates the claim based on several factors, determining which 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 use some software to take the patient data, prepare insurance claims, and hand them over to the appropriate party. There are two methods used to deliver insurance claims to the payer: manual and electronic. 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.
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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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Software Some healthcare providers use software to feed information to the CMS-1500 and UB-04 documents electronically. By using the fill and print software any chances of unreadable information is eliminated. 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. OCR (Medical Character Recognition) The Medical Character Recognition scans official documents, isolates and records information electronically in the varying fields, and transfers that data into other documents when necessary. The OCR technology helps make hard copy claim processing more efficient, but human oversight is still needed to ensure accuracy. Benefits of using the Electronic Medical Claim Bill Service Integration of the insurance company and hospital system is possible. Minimizes the time of reimbursement of insurance. The the system allows saving of more patient related electronic data than when using the manual records. It allows for customized patient medical and personal data that includes their medical history, tests, diagnosis, insurance policy and details of the insurer, and other relevant information. Fewer errors in application when using the electronic medical billing claim over the manual billing. There are several medical billing clearinghouses using electronic medical billing claims systems. 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 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 the insurance companies have their submission regulations and the medical facility may not know of this hence the need for clearinghouses.