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Medical Billing and Claims Management Explained

man using laptop for medical billing managementMedical billing management and medical claims management are two time-consuming facets of running a medical facility. However, as any good practice manager knows, they are crucial to achieving and sustaining profitability. If you are building a practice from the ground up or would just like to review the basics of the medical billing cycle and how to improve your medical billing and claims management, use this handy reference guide.

The Medical Billing Process

The medical billing process will be subject to the specific clinic and its established roles. In general, your health care facility sees patients and then documents the appropriate details of each visit, from session length to the reason for the visit (pain levels, location, medicines administered, etc.). You then employ a medical coding specialist to translate those details into numerical codes.

Those codes are logged and utilized to bill insurance providers as well as your patients. You are responsible for timely collections and billing maintenance, including HIPAA compliance and ensuring your patients the topmost level of data security.

Medical Billing Claims

Are you facing extreme negative profit margins? It might be because payers are transitioning from traditional fee-for-service to new value-based reimbursement. Or, it could simply be that your current medical billing process is inefficient as a result of poor documentation or lack of follow-through on medical claim billing.

Medical billing claims need to be made immediately and organized to facilitate timely reimbursement from both insurance companies and individual payers. Some health care organizations prefer utilizing a medical billing software that tracks and facilitates medical billing management. However, these programs can be easier to infiltrate by hackers, not to mention the extensive time required to learn and upkeep the system.

Whereas, Billing Advantage is a responsible third party billing agency that provides a top level of security alongside 24/7 access and support from experienced billing professionals. By hiring out your medical billing management needs, you can reduce time and money spent learning and managing health care billing, focusing instead on the mission of healthcare to your patients.

In addition, Billing Advantage handles medical claim management by pursuing your claims for quicker reimbursement and maximization to profitability. The additional profit far outweighs the small fees involved in hiring Billing Advantage. To learn more, get a price quote from Billing Advantage today.

 


Donna Whipple Donna Whipple

Donna Whipple, Psy.D. is a clinical psychologist with over 30 years of management experience. She has particular interest and expertise in HIPAA and ethical treatment and business practices in a changing high tech industry. She has a particular talent in boiling down complex regulations so providers can understand and comply with them. As co-owner of Billing Advantage Inc., Donna is involved in all aspects of the company but her particular contributions to the business is in mentoring upper level managers and helping them be more effective in their leadership.


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