In basic terms, medical billing is all about making sure the doctor or healthcare provider gets paid for their services. As simple as that sounds, payment often entails a fairly complicated sequence of events because both patients and insurance companies are partially responsible. Working through the complicated details is where a medical billing specialist or company can make a huge difference to your private practice.
What Does A Medical Billing Company Do?
1. Enters information into practice management software. Typical data entry includes:
- Patient information
- Physician information
- Insurance information
- Payment information
- Medical Billing Codes
- ICD Codes
- CPT Codes
- CPT Modifiers
A certain percentage of patient visits result in the use of similar or commonly used codes depending on the type of medical practice. Doctors will often enter these codes manually in lieu of using a coder by simply circling them on a patient interaction form.
2. Communicating between the related parties (patients, physicians, insurance companies, and government agencies).
When claims are denied, come back unpaid, need to be adjusted, re-submitted, and/or clarified, medical billing specialists are typically the ones responsible for doing the necessary research, correcting any mistakes, and preparing claims appeals as necessary.
3. Resubmitting or adjusting claims with mistakes and appealing denied claims.
Good medical billing companies will get the information correct the first time. This keeps your private practice from getting tied up in costly back-and-forth with insurance companies in a vain attempt to get paid. Ask your medical billing company about their claims denial rate or the percent of claims that have to be resubmitted.
4. Collecting payment from insurers and patients and posting any further bills to patients.
Medical billing companies are typically responsible for interpreting and posting the EOB (Explanation of Benefits) received from insurers. When patients have questions, medical billing specialists are often the most capable people to answer them.
From the private practice point of view, efficient insurance and patient collections is extremely important to the financial health of your business. Revenue cycle management is all about understanding the time-relationship between your patient’s visit and final payment for it. Oftentimes, private practices have nebulous data and insufficient knowledge about where their current revenue cycle stands and how to make improvements. Decreasing the time between treatment and final payment and increasing the percentage of payment actually received can make an extremely impactful difference for the business side of your private practice.