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Medical Billing Process

Medical billing process can be simply deemed as an interaction between the insurance company and physician. This whole process is dubbed as medical billing cycle. This process may take up days, even months to complete. Often many interactions and meeting are involved for reaching the final decision.

This process is initiated with visit of patient to the doctor’s office. The front desk office is responsible for recording the details of patient or simply updating the preexisting medical records. After checkup and diagnosis or even treatment, records are summarized after inclusion of pertinent information.  This information or data is futher digitized for regular and convenient updating in the future.

For the purpose of claim preparation, evaluation of diagnosis and treatment procedure is done by assigning a procedural code. For keeping a detailed account an additional numerical code is added depicting the verbal diagnosis statement.

For further processing of claims these electronic codes are transmitted to concerned insurance company. Usually claims are transmitted electronically, in very rare cases manual claims are transmitted to insurance companies for further processing.

Less complex medical claims are processed by medical claim adjusters. However, claims involving huge amounts of money are usually referred to a medical director for detailed scrutiny of the claim. After approval, physician / medical provider collects fee for the services rendered as pre-decided by insurance company. The rest of the unpaid fee (if any) is paid by the patients themselves. Denied claims are returned as EOB or ERA.

In case of denial, the claim needs to be corrected and resubmitted. It may often involve couple of more exchanges consecutively until the full reimbursements.

The number of claim denials is increasing day by day and is typically around 50% for any conventional practice, reason being the complexity of coding systems and medical billing procedures. Also in many cases the concerned insurance company does not cover the costs of a certain ailment under the health policy. A great deal of expertise is required on the part of medical biller to get the claims accepted.

SimplexMed can help you with this increasingly complex process. As the services of SimplexMed medical billing assists your practice throughout the medical billing process. The services of SimplexMed comprises of:

  • Efficient, accurate and complete data exchange
  • Electronic and paper claims processing
  • Aggressive AR follow up and insurance collections, payment postings & EOB analysis
  • Patient Statements and balance collections
  • Monthly practice analysis & collections reporting meetings