Medical Billing

Collecting and verifying patient information, including personal details, insurance information, and medical history.

Checking with the insurance company to confirm coverage details, including benefits and eligibility, to ensure the services provided will be covered. 

Translating medical procedures, diagnoses, and services into standardized codes. These codes are used to describe the patient's condition and the treatments or services provided. Common coding systems include ICD (International Classification of Diseases) for diagnoses and CPT (Current Procedural Terminology) for procedures. 

Entering the coded information into the healthcare provider's billing system to create a claim. This involves detailing the costs associated with each service provided. 

Sending the claim to the insurance company, either electronically or on paper, for payment. This process must comply with insurance company guidelines and regulations.

The insurance company reviews the claim to determine whether it will be paid, denied, or if additional information is needed. They evaluate the claim based on policy coverage, medical necessity, and other criteria.

In case of, additional information or resubmission of the claim our expert team will handle the queries.

Recording the payments received from insurance companies and patients. This includes updating the patient’s account to reflect the payments and any remaining balance due. 

Issuing bills to patients for any amounts not covered by insurance, such as co-pays, deductibles, or services not covered. 

Following up on unpaid claims or bills, including resubmitting claims if necessary, appealing denied claims, and collecting payments from patients. 

Ensuring that all billing processes comply with legal and regulatory requirements, such as those set by the Health Insurance Portability and Accountability Act (HIPAA), and generating reports for analysis and auditing purposes.