Doctors that treat patients are paid through insurance companies that are registered to the patients as the medical billing procedure suggests. The medical billers are appointed by hospitals and healthcare providers so that they can communicate with physicians and doctors to ensure the validity of the claim and then do a follow-up with the insurance company so that the company cannot back out from paying the dues. Healthcare service organizations and hospitals outsource the work to medical billing service companies rather than in-house billing so that the revenue cycle of the organization can be managed by a specialized medical billing company. By applying their knowledge at the right time and place medical billers also bring in profits for their organizations.

Why medical billing?

The doctor presents a diagnosis and check-up report that is much more complicated than the interaction that the doctor has face to face with the patient. When the insured patient visits the doctor or avails of any medical services, he/she has become a part of a three-party interaction.

The first party is the patient while the second party is the healthcare service provider. The healthcare service provider consists of physicians, therapists, hospitals, emergency rooms, outpatient services, doctors, and any other medical services. The third is a position taken up by the insurance company.

The medical biller is employed to reduce the gap among the three parties. Most healthcare organizations outsource the medical billing process to the top medical billing companies who have a team of procedural and physician coders and medical billers who have deep knowledge and experience of many medical procedures and all the related diagnosis. These companies specialize in medical coders and billers who will guarantee the reimbursement of the hospital through the patient as well as the insurance company. This billing procedure is very crucial as the insurance companies deny claims all the time to get out of paying money which causes a loss for the hospital.

The collection of information regarding the patient’s diagnosis and treatment is done thoroughly by the medical biller which is then presented in the superbill. This is compiled along with the doctor’s notes to form a claim. The patient’s demographic information, insurancecoverage, medical history and a report of medical diagnosis and surgeries are filedand sent to the insurance company.

The process of insurance

Insurance comes in several types

1. Managed care organizations
Lesser flexibility is provided to customers as this is an umbrella term encompassing Healthcare Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) and restricts the number of providers that can be visited by patients.

2. Indemnity
The patients can pay for the services and choose providers as per their requirements. The insurance premium costs more but there is more flexibility granted in this type. However, indemnity is losing popularity because healthcare prices are increasing and people cannot afford indemnity.

3. Consumer-driven healthcare plans

CDHPs or High Deductible Health Plans (HDHPs) deduct money from health savings accounts and health reimbursement accounts of consumers for bill payments. High deductibles at lower premiums are presented here.