What is Medical Claims Processing and Billing?

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What is Medical Claims Processing and Billing?
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• Whether you are a new Provider or an established
  healthcare practice, providing extra care to
  the medical claim processing sector is the only
  way to improve cash flow.
• Although patient care is the key focus of
  Physicians, many are new to the industry and lack
  the experience to handle medical billing.
• Well, it doesnt mean that experienced Providers
  are well-versed in claims processing, as some of
  them lack the latest technology software or
  professionals skilled in the new healthcare
  reforms.
• In either case, outsourcing medical claims
  billing is the best option! In order to learn why
  it is the right solution, Providers should
  understand how complex is the medical claims
  processing and billing. This article emphasizes
  just that

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What is Medical Claim Processing? 

• Then Providers render medical treatment to
  patients, they get paid by sending out bills to
  Insurance companies covering the medical
  services.
• It involves a lot of steps. Firstly, claims are
  prepared by assigning specific ICD (used for
  diagnoses) and CPT (used for treatment) codes to
  the medical services provided.
• These claims contain important information like
  patient demographics and plan coverage details.
• Then, the claims are submitted to the Payors.
• The insurance companies evaluate each claim and
  reimburse it accordingly.

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Medical Claim Billing in Depth

• Medical claim processing is not as simple as a
  walk in the park.
• It is a complex task that can be carried out only
  by skilled professionals who have great attention
  to detail, immense training in the new coding
  techniques, good communication skills, and
  knowledge on current healthcare trends.
• To be qualified by the Payors, claims have to go
  through many technical protocols and pass
  industry standards.
• HIPAA is one such standard that ensures
  high-level security during patient data
  transmission.
• Processed claims are filed electronically to
  expedite the process and improve efficiency.

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Clearinghouses

• The next step in medical claim billing is
  clearinghouses to which processed claims are sent
  to.
• It is a third-party hub that operates between the
  Provider and the Payor.
• Clearinghouses sort out all claims, scrub them
  for errors, format as per industry standards, and
  send to various insurance carriers.

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Explanation of Benefits

• After evaluating the claims, the insurance
  companies reimburse the Providers or reject
  erroneous claims if any.
• They should also provide EOB (Explanation of
  Benefits) to patients as well as Providers.
• EOB is a statement that shows several details
  like dates of treatment, diagnoses, charges,
  Providers reimbursed amount, and patients
  financial responsibility.

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Why Outsource?

• Anything can go wrong in this huge, complex
  process.
• Therefore, the in-house billing team should
  perform medical claim processing exceptionally
  well and conduct multiple audits before filing
  claims.
• If the team is not competitive enough to handle,
  then Providers can opt for outsourcing medical
  claim billing.

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About Us
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• If you are on the lookout for an
  experienced medical billing company, then
  consider MGSI, which has more than 20 years of
  experience in the healthcare domain.
• Based in Florida, this company possesses the
  latest technologies and software solutions to
  process claims without errors. 
• MGSI is A rated company with Better Business
  Bureau. 
• To learn more details, log on to
  www.mgsionline.com.

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THANKS

• Do you have any questions?
• Mail Us info_at_mgsinlne.com
• Call Us 1 877-896-6474
• Visit www.mgsionline.com