Case Study: My Experience With Claims

Medical Claims Processing There are several health care facilities all over the country, and they receive numerous patients each day for treatment. However, these hospitals have different qualities of services because they employ a labor force with different capabilities. Therefore, it not a surprise that health facilities do not offer equally quality services. One thing that would make a medical facility to stand out in its operations is the manner in which it processes its medical claims. Unlike in the past, many people today have medical insurance covers to cater for their expenses whenever they fall sick. Whenever patients visit the hospital for treatment, they are sure that the insurance company will cater for such expense and it is, therefore, the duty of the health facility to claim the payment from an insurance company. For timely payment, the health care facility must prepare and process the claims early enough. The processing of medical claims undergoes two processes which are coding and billing. Therefore, some facilities can manage to hire medical billers and coders separately while others that have limited resources may want to employ professionals who can do both billing and coding. However, those individuals that perform both duties earn more than those who do the jobs separately.
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Coding comes first before billing, and it is the first step which involves coding of various patients who come to the facility for different reasons. If this process is done hastily and shoddily, then there are high chances that the claim will not be successful. No insurance company will make any payment using incomplete records. Therefore, it calls for an expert who can do proper coding to this work so that it leads to a successful claim.
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The next step after coding is billing and its input is the information from coding process. Usually, the billing officer feeds the information into the computers. He must ensure that he fills all the required parts of the claim form and he submits it electronically to the insurance company. He must also make sure that he follows all the guidelines provided by the insurance company for claim submission. Therefore, depending on how the form is completed, the company may decide to reject or accept it. Depending on how billing is done, the company may reject or accept the medical claim payment. Due to the sensitive nature and informational requirements in filling the forms, there is need to use Medical Billing software. This software comes handy to help to process the insurance claims successfully. This software completes the process much easier to save time, and it is not prone to errors. It reduces medical operating expenses by reducing the number of employees. They ensure that every detail matches and all the requirements are met. It also has a database of all the codes and procedures which a staff member can easily refer to whenever processing a claim. With this software, you can be sure to process medical claims without any hitches.