When you work in the healthcare business, you need to work with patients and also with insurance companies and medical payers, such as Medicaid, which can make you feel like a go-between through the whole process. However, you can hire a medical billing service to help you handle this part of your practice so you can focus on what you do best — seeing and treating patients. Here are some functions you can expect to receive from a hired professional medical billing service. 

Insurance Verification and Approval

Your medical billing specialist will start out by helping you make sure your patient's insurance is going to cover the services they have arranged to receive and that your medical office is an approved provider by the insurance company. Insurance companies will have pre-established agreements with certain medical offices, and if your office is not set up to submit claims to, for example, Blue Cross Blue Shield, then you won't be able to submit claims to then.

Next, the specialist will make sure the individual is covered for the treatments and how much they will be required to pay, if anything. Most cases, the patient at the appointment will have to pay a co-payment amount, which is listed with their insurance information.

Process Claims

Your billing specialist will be able to input all the patient and appointments details into the billing system so it can be submitted to the insurance through an electronic claim. However, some insurance companies might not have electronic claim forms and your billing specialist will need to submit them via fax or mail. They will know the appropriate type of codes and data that is required for the claim, such as the type of disease, illness, diagnosis code, treatment, and any referrals.

This information in the claim will be submitted together to the insurance company, where it will be processed and either paid or denied. If the claim is denied, the medical billing specialist will need to check the information in the claim to find out why it was denied and correct any problems. For example, if the patient's name was spelled wrong or the middle name was submitted as their first name, this can cause problems with the insurance company's payment. 

Sometimes, the insurance won't pay the full amount that they should and the medical biller will need to review the claim and dispute the payment to try to collect the correct amount of the claim payment. During this period they will handle any questions from the patient to keep them in the loop of what is happening with their claim status.