Everything You Need To Know About Medical Billing

Let’s face it: medical billing is a confusing subject. It’s difficult to understand and even more difficult to navigate. The good news is, we’re here to help! In this guide, we’ll explore everything you need to know about medical billing in California, Virginia, New Jersey and other states and how outsourcing your practice can help you save time and money on the back end.

What is medical billing?

Medical billing is the process of processing and posting patient medical claims to an insurance company. Medical billing allows you to get paid for the services you provide. The medical claims process is complicated, and involves many parties. It’s important to understand how each party contributes to the larger picture of processing claims.

Medical billing is a huge part of your practice, and it has a significant impact on your bottom line. The more efficient you are with processing claims, the faster you’ll get paid and the better your cash flow will be.

Medical billing professionals are involved in the following:

• Receiving medical records from patients, physicians and other healthcare providers.
• Coding those records using International Classification of Diseases (ICD-10) codes for diagnoses and procedures (used by all states except California) or Current Procedural Terminology (CPT) codes for procedure descriptions. The latter system is used only by Medicare and Medicaid, since private insurance companies use their own coding systems.
• Submitting claims to payers including health insurers, managed care organizations like HMOs or PPOs, pharmacy benefit managers (PBMs), workers’ compensation funds and self-funded employer plans that cover more than one state

The term “medical billing” is also sometimes used to refer to the entire process of submitting claims for payment from insurance companies, including both coding and billing.

Medical coding is the process of translating a patient’s medical record into code. It involves assigning alphanumeric codes to diagnoses and procedures reported by physicians and other healthcare providers in clinical records. Medical coding is one of the most important areas of medical billing, because it allows healthcare providers to communicate with insurance companies and other third-party payers. It’s also an integral part of patient care, because accurate medical coding ensures that patients get access to the right treatment for their condition.

How does medical billing work?

Medical billing is the process of submitting a claim to an insurance company or third-party payer for payment. Medical billing is also known as “health care claims processing” or “healthcare reimbursement”.

Medical billing services are provided by medical billers who specialize in providing revenue cycle management services to physicians, hospitals, clinics and other healthcare providers.

In many cases, the same person that performs the coding also performs the billing. However, it is possible for these two functions to be performed by different people (especially in larger organizations). The basic steps involved in medical billing in Washington, Arizona, Tennessee, Wyoming and other states include:

• Coding
  The act of assigning codes to patient records based on their diagnosis and treatment. This is done by a trained medical coder who knows all the codes that apply to all the diagnoses and procedures they may see in their practice. In some cases, this can even happen automatically by computer software, which then assigns codes based on keywords found in a patient’s EMR record.
• Billing
  The act of submitting claims to payers for reimbursement on behalf of patients treated within your practice. This usually involves using software designed specifically for health care practices, combined with human resources to address what software misses.  This can be a complex and tedious process, as it requires a great deal of attention to detail. The insurance company has its own set of rules that you must abide by when submitting claims for payment, so you’ll need to make sure that each claim follows those rules carefully.

In addition, many different entities are involved in medical billing — including doctors, health care providers and insurance companies — so communication among all parties needs to be clear and consistent.

Furthermore, medical billing is often time-consuming, which means that most practitioners don’t have the time or energy required for such an endeavor.

Medical billing is a necessary part of running a medical practice, but it’s also an expensive and time-consuming task. If you’re not equipped to handle your own billing needs, it can be worth your while to hire an outside company that specializes in this area. Not only will they provide additional income for your practice, but they’ll also free up your time so that you can focus on other parts of the business.

Benefits of Outsourcing Medical Billing

Because medical billing is a complex process that involves a lot of people, including healthcare providers, insurance companies and patients, there are many issues that can arise during the billing process.

This is why it’s important to outsource medical billing to professionals who have experience handling such tasks. Outsourcing medical billing enables you to focus on your core business while leaving the rest to experts who know how to handle difficult situations and how to get paid for services rendered.

Reduces costs:

Outsourcing medical billing to a dedicated team of experts can reduce the overall cost of providing healthcare services. Outsourcing medical billing to a third-party company can help you save money because it eliminates the need for expensive on-site equipment, software licenses, and staff hiring and training. You also don’t have to pay for benefits or payroll taxes for these employees, which lowers your overall costs significantly.  This means that you don’t have to worry about investing in new technology or hiring more people just to get your invoices paid.

Improves Efficiency:

Medical billing requires a lot of time, so if you outsource it, then you can free up more time to focus on other aspects of your business. This can be especially helpful if you have multiple locations or if you need to grow your practice. Outsourcing medical billing helps you focus on what matters most, which includes improving efficiency in providing care and reducing operational costs.

Better Financial Reporting:

Outsourcing medical billing to a team of experienced professionals will help you increase your profits by ensuring that all claims are submitted accurately and on time. This results in better financial reporting, which is necessary for any practice to grow or maintain its current level of success.

Improves Staffing Flexibility:

Medical billing outsourcing allows you to focus on other aspects of your business without having to worry about the time-consuming task of processing medical claims. This helps to improve your staff’s flexibility and productivity levels, as it allows them to focus on more important tasks such as patient care, growing your practice or client services.

Increase Focus on Patient Care:

Outsourcing Medical Billing Services frees up time for you and your staff so that they can focus on patient care instead of spending their time on paperwork and mailing bills. The ability to focus on patient care is important because it helps you to provide better service and achieve higher levels of satisfaction among your patients. This can help you attract new patients as well as retain existing ones.

Improves Cash Flow:

Outsourced medical billing companies can help you improve cash flow, which is especially important for smaller practices. This is because they often have deep experience with Medicare and Medicaid as well as private insurance company billing. They also have more resources for the often expansive paperwork and phone calls which are needed to successfully process claims and collect payments.  This allows practices to get paid more and faster than they would without an outside party involved.

Medical billing is an ongoing process that requires constant monitoring and updates. This can put a strain on your cash flow if any errors are made during the process. Outsourcing your medical billing allows you to concentrate on running your practice while leaving the task of managing accounts payable to someone else.

Medusind Medical Billing Services

Medical billing is a complex process that can benefit from being outsourced. Medusind has worked with thousands of clients across the country; we learn from our clients’ experiences, and make changes to our services based on what they tell us.

This means that when you use Medusind as your outsourced medical billing service, you get all the benefits of working with an experienced and dedicated team – assigned as an extension of your practice – that adapts to your needs as they change over time. We provide flexible end-to-end solutions for our clients and partner with them to make sure that they have access to the services which fit their specific and unique medical billing needs. 

To learn more about our services, you can contact us today!