Medical expenses are too much of a burden to carry. That is why most people would opt to subscribe to Health and Medical Insurance to lessen the weight of the cost of maintaining their health. Medical bills ensure that the expenses incurred when availing for the services from medical and healthcare providers are evenly distributed between you and your health insurance company.
What Are Medical Bills
Medical bills are bills that summarize the details of the services availed by the patient from healthcare facilities. Much of the details inside a medical bill comes from the doctor’s diagnosis and lab results which are compiled into a “Superbill.” Medical bills also contain demographic information of the patient and their medical history. Medical bills are transmitted into claims to Insurance Companies to appeal for compensation for the services provided by healthcare providers.
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The Medical Billing Process
The Medical Billing process might sound complicated and confusing, but it only involves six simple steps to follow. The following steps are the Patient Registration, Financial Responsibility Confirmation, Diagnosis, Treatment, and The Superbill, Preparation and Generation of Claims, Submission of Claims, and Payment Collection.
Step 1: Patient Registration
The process starts once a patient schedules a visit to a healthcare facility. Upon arrival, the patient writes down their information on the registration form, especially if it is their first visit. It includes the Patient’s Personal Information, Patient’s Insurance Information, and the Patient’s reason for the visit. This information will be used to set-up a file on the Patient and update their database. It also acts as a reference during the billing process.
Step 2: Financial Responsibility Confirmation
During this phase, the biller will determine who will pay for the services rendered by the facility. The patient’s insurance information will be checked to know up to what extent is covered by the insurance policy so that the biller could issue the correct bill. Coverage varies differently between insurance companies, individuals, and plans. The biller must check that information so that they can advise the patient on which procedures will be billed to them and which ones are shouldered by their health insurance.
Step 3: Diagnosis, Treatment, and The Superbill
Information is also collected during the meeting with their doctors. The information during the meeting includes symptoms, treatment, or advice to undergo lab testing. Lab test results are also collected to determine which tests were performed to the patient. These are compiled into a Medical Report which consists of the patient’s lab test results, symptoms, treatment, and medical history. These are then sent to the Medical Coders to convert them into valid, useable medical codes. After Conversion, a “Superbill” is generated, which is a compilation of the services availed by the patient.
Step 4: Preparing And Generating Claims
Billers will then review the codes to ensure which procedures are billable after receiving the “Superbill.” The procedures covered by the patient’s health insurance will differ according to its policy. After reviewing the codes, the biller will now prepare a charge entry based on the medical codes and the patient’s insurance coverage. A medical bill or a claim will then be prepared, which will be transmitted to the patient’s Insurance Company to appeal for compensation for the services rendered by the healthcare provider.
Step 5: Transmitting Of Claims
After a medical bill is prepared, it will be transmitted to the patient’s insurance company. The insurance company will then receive these claims and reviews them. The information contained in the medical bill or claim will be checked against the patient’s insurance coverage. After the company reviews the claim, they will issue an order of payment to the healthcare provider.
Step. 6 Receiving Payment
Payment will be sent after the insurance company issues an order of payment to the healthcare provider. The healthcare provider will collect the payment both from the patient and the insurance company. After the payment is made and received, a file will be prepared and stored with the patient’s records.
Tips On How To Prevent From Being Wrongly Billed.
Insurance companies often don’t cover the entirety of the medical expenses and Billers issue notice of payment to patients with outstanding balances. It will come as a shock to us to find out that the medical treatment and procedures that we underwent weren’t covered by our insurance policies. Oftentimes, such problems are caused by miscommunication between patients, health providers, and insurance companies. Written below are tips to keep in mind in order to avoid such hassle.
- Review your insurance policy coverage: Always review your insurance policy coverage before availing for services from a healthcare facility. Take note of its particulars, especially illnesses, medical procedures, and medical benefits covered. In that way, you can be financially prepared for any eventuality that is not covered by your insurance policy.
- Always have your latest insurance ID onhand: Keeping the latest insurance ID onhand ensures that billers are transferring the correct information every time you undergo lab tests and treatment. Also, it prevents billers from billing the wrong information and amount to you and your insurance provider.
- Never assume that everything is covered: Each time you set an appointment and schedule a visit to a healthcare facility, never assume that everything is covered by your insurance. Always review your insurance policy. Remember, health insurance policies don’t cover everything.
- Have an open line of communication with your health insurance provider: Always have the option to communicate with your health insurance provider. Communicating with your health insurance provider before availing of medical services or after receiving medical treatment gives you fewer things to worry about later. It also prevents misunderstanding between you, your healthcare provider, and your health insurance provider.
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