Claim submission in Medical Billing
Claim submission process in medical billing is one of the important steps in the medical billing process. It decides the amount the health care provider will receive after the insurance company clears the dues. The health care provider’s reimbursement depends on proper submission of medical bills to the insurance company. If we follow claim submission process correctly, health care providers will receive the reimbursement in time. Otherwise the claim may be denied or rejected.
The Claim submission begins after the medical coding and processing of claim. We submit the claims nowadays by Electronic Data Transfer (EDI).
We follow the following steps for proper claim submission.
Electronic Health Record:
- We check the relevant information on Electronic Health Record (HER) software for electronic claims medical billing. Medical biller will check the code entry and all relevant fields properly so as to avoid errors.
- It requires patient information, patient demographic information, including personal and contact information, patient referral or appointment scheduling, patient health history, Insurance eligibility verification.
Services Not Covered:
- We inform the patients about services and procedures not covered in the insurance plan and about copayments.
Correct Billing Codes:
- Medical coder will receive the patient’s medical report. Medical coders will dig out relevant billable information from the records and assign the correct billing codes ICD-10 codes for diagnosis and CPT and HCPCS codes for services / procedures performed.
- We prepare the Superbill. Our team enters all the charges into practice management software beside the expenses borne by the patient at the period of service. The superbill will contain patients’ information, health care providers information, medical codes and all related information. Health care providers may add supportive documents so that all relevant information is added.
- Next step is claim scrubbing. In this biller will check the codes and validate that all the data entered is correct and all the services added are billable.
- We present the claims on a specific form. We use CMS 1450 or UB-04 for hospital practices and CMS 1500 for submitting medical bills to Medicare.
- Once we receive the claims, the insurance company will determine its authenticity and rule out how much the company will reimburse the provider. Insurance companies may accept or reject a claim depending on all the information. The insurance company will send Electronic Remittance Advice (ERA) back to the provider. We call this report ‘adjudication’. The report includes the explanation of why it does not cover certain procedures. Besides this it also provides the reason for the denied and rejected claim.
- Payment is included in patient statement which has to be paid by the patient, which is not covered by the insurance company
Benefits by our Claims Submission Team at Ibex
Ibex Medical Billing claims submission team offers:
- Claim denials are avoided by addressing issues beforehand.
- Accounts Receivable is improved due to reduced number of denied claims.
- Accomplish greater and faster reimbursement
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