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 the insurance company then assesses the claims based on some factors to determine what claims to cater for if there is any. 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. There is a software that the medical billing professionals use to record patient data, draft the claims, and submit them to the suitable 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 the method is more accurate, more inexpensive and fast to process.
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Filing Insurance Claims Electronically 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. The chances of having unreadable information is reduced by using the fill and print software. This the software may also include specific tools that can check for any errors in the document. 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. While the OCR technology helps in making the processing of the hardcopy claims more efficient, human control is required to ensure accuracy. Advantages of Electronic Medical Bill Claims It allows the integration between hospital system and insurance company system. The time of insurance reimbursement is minimized. 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 application when using the electronic medical billing claim over the 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. The clearing houses receive claims from the hospital, remove any errors from them, put it in the recommended format, then submit it to the relevant parties. The clearinghouses play an important role because hospitals have to send high-quality insurance claims each day to different insurance providers. 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.