Medical Billing Service-Improves Revenue and Cash FlowMedica

1. Medical Billing Services Improves Revenue and Cash Flow

2. Medical insurance claim • An insurance claim begins with: • A patient • A provider • A service provider to a patient

3. Patient can contact by means of: A Walk-in An Appointment Emergency visits Scheduled Surgery “Rounds” ( hospital daily care, hospital visits etc.) Scheduled Admissions

4. What patient should inform to doctor? • The nature of the appointment should be identified of the patient to know about his/her health issues. • The patient must inform the health provider about any insurance coverage that he have and also should inform about the changes in the policy if any.

5. Medical Billing Servcies Medical Billing Services is a great mechanism in the field of healthcare that makes the billing cycle more efficient and easy to manage. This process is done in order to take payment delivery when a healthcare domain provides their services to the patients. The medical billing system is a general interaction between the providers and payers where healthcare domain comes in providers and the Insurance companies comes in payers. This complete provider-payer interaction in Medicare domain is also known as Medical Billing Cycle.

6. What is an EMR? An EMR is a health record of the patient that can be understood as a database which is consisting of all the details of patient. The details of patient can be the demographic information or information of the complete treatments that have been provided. Demographic information mainly includes the personal details of the patient like his/her name, address, phone number, summary of the treatment and id of insurance policy. In other details section it contains information regarding recommended treatments, prescriptions, checkup details, diagnoses and many more.

7. Information essential on a Claim • When a claim process starts then some sort of information is required from the patient related to his/her insurance policy. Some of them are: • Patient identifying information • Patient insurance information • Patient Diagnoses • Patient Services • Provider information • Site of Service information

8. Initiating a claim • 1. For a non hospital setting: • Patient’s information is provided by means ofschedules, visit logs or other information. • Charge tickets are utilized by providers to communicate the services offered to the bill following scheduled visits. • Physicians or other professional of healthcare will select the diagnoses/services best describing the patient encounter. • 2. For a hospital based setting: • Physicians select the diagnoses/services best describing the patient encounter • Diagnoses and services are communicated to professional coding staff • Encounter documents are verified for correctness and precision • Encounter documents are sent for billing • Services are arbitrarily chosen by the coder for review to authenticate services are billed as documented in the medical record

9. Coding Experts track patient encounters and service logs provided by the physician office • Coding staff will then categorize possible encounters performed by their assigned physicians • Coding staff will evaluate medical record documentation for the appropriate and valid services. • Service will be coded and recorded on the suitable encounter document • Encounter documents are then batched for billing

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