1. Claim Submission: When you visit a doctor or a hospital, they provide you with medical services. After your visit, the medical billing company takes the information about the services you received and sends it to your insurance company. This process is called claim submission.
2. Insurance Verification: Before your visit, the billing company checks with your insurance company to confirm what services are covered under your plan. This helps prevent surprises later on about what your insurance will pay for.
3. Prepare Insurance Claim: Once your visit is done, the billing company prepares a detailed bill, or claim, to send to your insurance company. They make sure it includes all the right codes for the services you received.
4. Accounts Receivable Management: This is a fancy way of saying the billing company keeps track of all the money owed to the healthcare provider from different patients and insurance companies.
5. Patient Payment Collection: If you owe any money after your insurance pays its part, the billing company will send you a bill and make sure you pay it.
6. Claim Denial Resolution: Sometimes insurance companies deny claims for various reasons. The billing company works to figure out why the claim was denied and resubmits it if necessary.
7. Credentialing: Before healthcare providers can work with insurance companies, they need to be approved, or credentialed. The billing company helps with this process.
8. Patient Registration: When you first go to a doctor or hospital, you have to fill out forms with your information. The billing company makes sure this information is correct and up to date.
9. Charge Entry: Every service provided by a healthcare provider has a specific code that represents it. The billing company enters these codes into the system to create the bill.
10. Compliance: Healthcare billing is a complicated field with lots of rules and regulations. The billing company makes sure that all the billing practices follow these rules.
11. Denial Management: When claims are denied, the billing company works to fix the issues and get the claims paid.
12. Payment Posting: When the insurance company pays for a claim, the billing company records this payment in the system.
Medical billing company takes care of all the paperwork and communication between healthcare providers, patients, and insurance companies to make sure everyone gets paid correctly and on time. They play a crucial role in keeping the healthcare system running smoothly.