4 Things You Need to Know About Medical Billing

09/06/2016 09:58 am ET Updated Dec 06, 2017

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Screenshot: Medical billing

There is this wild saying that the healthcare system is really designed to reward you for being unhealthy.

Medical billing is a payment practice within the United States health system where healthcare providers like your doctors, nurses, orthopedists, dentists etc, submit and follow up on claims with insurance companies, in order to receive payment for services rendered such as treatments, investigations and so on.

Before now, medical billing used to be done entirely on paper; filing, submitting claims, etc. But with the advent of medical billing software, healthcare providers can now efficiently manage and submit claims and receive payments for a lot of people.

1. Medical billing is the bridge between your healthcare provider and insurance company: Medical billing is the process where your healthcare provider sends an invoice detailing your treatment and the health services received to your health insurer for payment.

This invoice is called a claim. Sometimes, your insurance company pays it all and sometimes you might need to pay part of it. That is what you call co-paying.

If there is one thing insurance companies are great at, it is their inability to pay up and their tendency to lower the cost they have to pay.

I mean we've heard horror stories where insurance claims are severely contested by insurance companies leading to a loss of income for the hospitals and denied healthcare for the patient.

This has led hospitals and hospices alike to significantly increase the cost of medical procedures to more than make up for any loss and to employ the services of professionals like medical billers.

2. Good medical billers boost company bottom line: Medical billers have always been a staple of healthcare institutions. But they do more than just file claims for insurance, knowledgeable medical billers can boost the revenue of medical practices.

Medical billers prepare claims for insurance companies and ensure that the practice receives payment for work done.

Also, they regularly communicate with physicians and other healthcare professionals to clarify diagnoses and to obtain additional information about your treatments and what not. Bet you didn't know that, did you?

You totally don't want the case where you are slapped with a bill for acompletely unrelated procedure when you had a mere CT scan.

With that said, the financial health of your health service providers not only depends on your continued patronage; it also depends on the excellent performance of medical billers.

3. Medical billingmakes use of specialized software: Like I said, medical billers prepare claims for insurance companies and ensure that their establishments are properly reimbursed and remunerated.

Medical billers are in charge of activities like processing patient data, such as treatment records, patients' diagnoses and related insurance information. Multiply this task by more than a 100,000 patients yearly and it can get cumbersome really fast.

To reduce the risk of error, medical billers andbilling servicesmake use of specialized software to efficiently manage client information and insurance claims.

Medical billing software allows for excellent streamlining of billing activities from claim submissions to managing insurance and patients' payments and patient billing.

These web or cloud-based software allow billers and healthcare providers access their system from anywhere which probably explains why billing services are now outsourced to medical billing services.

4. Sometimes medical billing is outsourced to medical billing services: The sobering fact of health care in the United States is that there are far fewer hospitals now than there were even ten years ago.

With health insurance outsourced to insurance companies and hospitals typically getting an approximate 10% reimbursement of total health service cost, many hospitals are starved of necessary cash flow.

For a medical practice to stay above water or even thrive depends to a large extent on their billing department.

The more statements they can get out to patients and the more claims they can get the insurance companies to pay, the faster they'll be bringing money into the practice.

Usually, medical billing is handled in-house. Some medical offices have one employee(s) that specifically runs the billing department. Other times, it is mostly outsourced to medical billing services.

Medical billing services regularly send claims on behalf of their clients (healthcare providers) to insurance companies and are contractually obligated to follow up on all unpaid and denied claims.

Also medical billing services handle everything about billing in a timely manner leaving healthcare professionals to focus on what they do best- administering treatment.

Another advantage of outsourcing your medical billing is that you are able to objectively assess the performance of your billing providers. Billing services are required to regularly provide an up-to-date performance report for their clients.

With this report, you are not only able to see how well the practice is doing, you will be able to evaluate the performance of the billing company.
Hospital and doctor's office visits are becoming more expensive. Most Americans who file for bankruptcy do so because of high debt from medical expenses.

Another reason for this (besides inflated health care costs and insurance companies' gorging of medical costs), is common medical billing mistakes.

Common mistakes made by the medical billing community include duplicate billing where billing staff bills you and insurance twice.

Another is unbundling where you are charged for each separate procedure that should have ordinarily gone together.

Also look out for upcoding charges; a practice where a doctor or hospital uses improper billing codes and charges for a more expensive service than what was actually done like charging you for invasive heart surgery when you only went for a flu shot.

The first step to protecting against potential ruinous medical charges is education- update your knowledge of medical charges and billing statements, shop around for the best health insurance packages and keep good records of all your medical transactions.