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Insurance claims need to be settled for almost every medical case. Doctors, clinics and hospitals have to implement a seamless medical billing process to settle claims with insurance companies. Hence, the process of medical billing and claim filing is quite rigorous. Here is a brief gist of the process and the various steps involved in the course of medical billing.
Generally, medical billing can be done only by skilled professionals. Most large medical establishments and hospitals have a department dedicated to this process. Also, this process is a requisite for any organization and without it obtaining payments from insurance companies will be extremely difficult. The process begins with accurate creation and maintenance of medical records. Tests, examinations and medical diagnosis are carried out to check the health condition of patients whenever they visit a medical establishment. This is the basic medical record which is further used to generate the bill. Also, the insurance information should be provided to the clinic or hospital.
The bill ultimately has to be submitted to the insurance company. For this, it should be coded first. There is a standardized system that is used for this coding. Using this system, a CPT and Diagnosis code is assigned to every process or service. After the completion of the coding process, the bill has to be dispatched to the insurance company. After the insurance claim is received by the company, it is reviewed by them.
The bill can then either be approved or even get rejected. Then the notice regarding the payment, whether it is acceptance or denial is sent to the health care establishment. Even the patient has to be informed about the status of the claim at this time. Sometimes the entire bill is approved and on other occasions only a portion of the payment is granted. Whatever the case is, the patient then receives an ‘explanation of benefits’ (EOB) letter informing them of the result of the claim. If the claim has been denied then an appropriate reason has to be provided by the company.
Thus, the process of medical billing is straightforward and goes through many entities before an insurance claim is approved. Every step of the medical billing process must be carried out with diligence and accuracy. This will assure that the medical billing process remains easy and cuts down hassles in a medical establishment.
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