Medical billing and coding are a unique field that manages the financial records of healthcare facilities. The job description usually requires a Master's degree in healthcare or related fields, and at times some specialized training or certification. Medical billing and coding specialists are responsible for collections of and communicating information about patient medical accounts, insurance claims, appointments, prescriptions, tests, and other services. They are also responsible for creating patient accounts, insurance claims, and keeping track of important healthcare information.
Though Medical billing processes in the past were often done manually, through the use of various software programs, electronic and Internet-based systems, billing and coding systems have greatly improved. This has reduced human errors and increased accuracy, thereby reducing healthcare expenses. Medical billing and coding systems can be used for everything from basic health information to complex patient information. It includes everything from patient medical history to vital signs and laboratory and radiology data. A successful system will incorporate a variety of electronic patient records into a uniform, clear, easy-to-read format.
Some providers perform all or some of their own medical records while others outsource the work to third parties. Providers who do their own medical record management typically do so because they are the clientele. They prefer complete control over the system, although they may pay an independent service to maintain it for them. Such providers have a variety of needs, depending upon their overall business model. For instance, smaller providers often need to outsource routine claims processing to make certain that they are processing claims accurately and in a timely manner. Large providers may be able to afford onsite staff to manage their electronic medical records and payers.
There are three primary payers in any healthcare revenue cycle. The payer is the provider or the client, and the provider organizations are either payers or vendors. The provider organizations retain and remit health claims to payers, while the payers retain and remit payments to the providers. The third player, the vendor, makes money off the profits of both payers and providers. Because this is a three-way revenue cycle, both parties derive a profit.
As part of the healthcare provider's revenue cycle, the claims process is not only the purview of a single person. Claims processing is a collective effort, involving numerous people from various departments within the provider organization. In order to provide excellent claims, it is important for the claims department to have the requisite expertise and experience. This is where medical billing outsourcing comes into play.
Online vendors are able to submit claims to multiple payers simultaneously. This allows them to reduce administrative costs. The vendor then submits its own invoices to each payer individually. Rather than having to hire additional personnel, payers need only to make one payment to the vendor, rather than sending different bills to different departments within the organization. With this streamlined process, healthcare providers will be able to submit claims to multiple insurance companies and multiple payers at a fraction of the cost and in the shortest time possible.
Add paragraph text here.
