Medical Billing

                                                                                                                  

Medical Billing: 

It is a process of submitting & following-up on claims with the insurance companies to receive payment for the services rendered by a healthcare provider.

Responsibilities of Medical Billing Company:

• We work for the providers.
• We bill the insurance companies on behalf of providers.
• We make sure that all his bills are paid.

Revenue Cycle Management:

The Revenue Cycle Management process flow clearly explains to us how the Financial Data Management for the provider is carried out. It gives us a picture of how we generate the revenue for the provider and is managed.

The RCM starts with the first entity which is the patient being classified in to ‘New’ and ‘Existing’.

A New patient can be defined as the one who has not visited the provider’s office at least one in the past 3 years.

An Existing patient can be defined as the one who has visited the provider’s office at least one in the past 3 years.

Types of Jobs:

AR Analyst, Payment Posting/Charge entry, Eligibility Verification, Medical Coding, Medical Transcript Correspondence etc.

AR Analyst: In this we work for provider and look for denials. Basically we need to check why the claim was not paid. We need to f/u with insurance or payer. The claim may deny due to various reason; They are

• Claim Denied as Duplicate
• Claim denied as patient policy termed at the DOS.
• Claim Denied for COB information
• Claim denied for EOB
• Claim denied for Untimely filing.
• Claim denied as Provider NPI is not enrolled with State.
• Claim denied as services are not covered under patient plan/ provider contract.
• Claim denied for Global period.
• Claim denied for Baby birth weight is missing.
• Claim denied for medical records
• Claim denied for CPT code is inconsistent with Place Of Service
• Claim denied for services are Bundled
• Claim denied as Primary paid more than secondary allowed
• Claim denied as Accidental information required 
• Claim denied for Authorisation
• Claim denied for Pre-existing information required
• Claim denied for missing/ invalid POA indicator.
• Claim denied as Modifier is inconsistent with CPT code.
• Claim denied as Dx code is invalid with patient age.
• Claim denied as patient Gender mismatch
• Claim denied as revenue codes are incorrect
• Claim denied for incorrect Type of Bill
• Claim denied as additional information required.
• Claim denied as processed under capitative
• Claim denied as allowed amount applied to patient deductable.

I the claims get denied for the above reason need to resolve for payment. Once payment is made the payment receipt (known as EOP/EOB) with check need to send to posting team. The account become zero. This way RCM cycle is getting completed.