Medical billing outsourcing is a process that performs financial management to Healthcare Providers and Hospitals. Once the Healthcare provider renders service to patients, the details of service rendered and their insurance details are intimated to medical billing outsourcing team. The medical billing team submit and follow-up with the insurance company to get the payments to the healthcare provider.
Medical Billing Outsourcing Process/ Cycle
Medical billing outsourcing process/ cycle involves four departments that go on to ensure payment from insurance company to the healthcare provider/ Hospitals. They are as follows.
- Coding Department
Once the Healthcare providers render service to patients, the coding department translates the services to the appropriate diagnosis code as per ICD 9 (International Classification of Diseases) and appropriate treatment as per CPT (Current Procedure Terminologies).
- Charge Entry Department
Compiles the demographic details of the patient, Insurance details, Diagnosis code and CPT code and submits the claims to a clearing house through electronic billing process. The clearing house transforms the claim as per the standard format required by the insurance company and sends the claim to insurance company.
- Electronic Claims Submission
Submitting the claims electronically is more accurate, timely, and easy to keep a track and reduces paper work. The quality team having checked the accuracy of the charge entry submits the claims to a Clearing House. Every insurance company has a format of their own. The clearing house re formats and sends the claim to the insurance company as per their format.
- Payment Posting Department
The insurance company reviews the claim and prepares an EOB (Explanation of Benefits) statement and informs the patient as well as the Healthcare provider. This statement gives out the details of claim whether approved/ not approved and the reasons there to. The Payment posting department compiles all EOB and closes all claims for which the payment has been settled. The claims that have not been settled due to rejection/ want of further information are sent to AR (Account Receivable) Follow up Department.
- AR (Account Receivable) Follow Up Department
This department takes care of all the rejected/ want of further information claims and follows up with insurance company and the healthcare provider till such time the payment is settled from insurance company.