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medical billing services
How Medical Billing Services Can Increase Cash Flow
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By: Arlette Measures
A Quick Guide to Medical Billing Services

Building and managing a successful health care practice can be challenging. Physicians, dentists and other health care providers often find themselves spending more time than they would like on the management side of their practice. Preferring to focus their time and attention on their patients, many medical professionals decide to outsource their billing functions to a medical billing service.

This guide is designed to assist health care providers in making an informed decision about whether to use medical billing services. You will also find tips for selecting the right service provider for your practice if you do choose to outsource your billing.

Facts About Medical Billing Services
Collecting payment for medical services is seldom a straightforward process. It involves painstaking attention to detail to ensure accuracy. It can also require a huge dose of tenacity and patience when dealing with insurance companies and slow-to-pay accounts. Smaller practices often simply do not have the time to handle billing and collection procedures adequately. Larger practices, as well as hospitals and clinics, often utilize medical billing services to save costs and increase collection results.

How Medical Billing Services Work
The main purpose of a medical billing service, of course, is to ensure that health care providers receive reimbursement for all medical services rendered. This involves a number of detailed tasks upon receipt of each medical bill or statement. The medical biller must check all forms for errors, negotiate with collection agencies, answer patients’ questions about their health-care plans and explain to them the office's billing process.
And quite often, they spend many hours negotiating with insurance companies on behalf of their clients.

After each appointment a medical biller will review forms attached to the patient's record to confirm which services were provided. The medical biller must carefully compare the doctor's notes on each patient’s chart with the encounter form to verify such details as diagnosis codes, services rendered, and duration of the visit. Next, the medical biller will re-check the patient's insurance coverage, noting the name and contact information of the insurance company. They frequently need to review the patient’s insurance benefit policy to be certain they are billing only for allowed procedures and amounts.

When everything is in order, they will prepare the proper invoices and submit the claim to a clearinghouse.
This systematic procedure of billing and collecting professional fees for medical and healthcare services also includes:

• Sending claims to insurance companies
• Recording payments
• Responding to information requests related to claims
• Following up on claims that receive no response
• Communicating with patients and insurance companies regarding claim status
• Sending statements to patients
• Collecting patient co-payments
• Sending reminders for past due accounts
• Collecting accounts receivable
• Turning delinquent accounts over to a debt collection agency
• Appealing denied claims


This process requires a broad range of knowledge and understanding of the medical billing procedures and health insurance regulations. The medical biller must be familiar with medical terminology involving diseases and diagnoses and be able to translate these into coded billing statements. They must also be adept at entering patient information into databases, mailing patient billing statements, posting payments received, following up on unpaid insurance claims, as well as appeals and denials, and reporting to their clients on the financial status of the practice.

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