Medical Billing Services for healthcare providers in the USA
Key Functions of Medical Billing Services
Patient Registration and Verification:
Collecting and verifying patient information such as demographics, insurance details, and medical history.
Ensuring that all necessary information is accurate and up-to-date to prevent claim denials.
Insurance Verification and Authorization:
Verifying patient insurance coverage and benefits before services are rendered.
Obtaining pre-authorization or pre-certification from insurance companies for certain procedures if required.
Coding:
Translating medical services and procedures into standardized codes (ICD, CPT, HCPCS) used for billing.
Ensuring coding accuracy to maximize reimbursement and comply with regulatory standards.
Claims Submission:
Preparing and submitting claims to insurance companies and government programs like Medicare and Medicaid.
Ensuring timely submission to prevent delays in payment.
Payment Posting:
Recording payments from insurance companies and patients.
Reconciling payments with outstanding invoices and updating the system accordingly.
Denial Management:
Identifying and addressing reasons for claim denials.
Resubmitting corrected claims and following up with insurance companies to ensure payment.
Patient Billing and Collections:
Generating and sending patient statements for balances due after insurance payments.
Managing payment plans and collections to recover outstanding balances from patients.
Reporting and Analytics:
Providing detailed financial reports to healthcare providers.
Analyzing revenue cycle performance to identify areas for improvement and ensure financial health.
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