Medical Billing Claim process

claim processing in medical billing in new york

Does your business require the extreme benefits of time and cost saving solutions? Are you looking to increase benefits and efficiency, diminish collection times and process claims successfully? If yes, then you are at perfect place. AccuretRCM can guide you further in this direction.

Medical Billing is one of the fastest developing and most dynamic sectors of the medicinal services industry. Medical Billing is a complex procedure of invoice and gathering money for the health care administration provided to the patient. To run a profitable medical business, healthcare facilities and hospitals should follow a compelling method for collecting reimbursement. Electronic medical billing is imperative to run a successful practice.

Medical Billing requires efficiency and accuracy which is vital. Medicinal billing is the procedure in which there is follow ups and submissions of clams to insurance agencies in order to get the payment of administrations provided by a health care supplier. Claim procedure is also used for many insurance agencies, whether they are privately owned or government owned companies.

The procedure followed by medical billing claim process is as follows:

  • Claims Transmission: The medical claim is being forwarded to medical billing companies by the hospital.
  • Retrieval and Checking of Medical Claims: All the documents are checked by the companies.
  • Medical Coding: Diagnosis codes are fixed for the patients.
  • Charge Creation: Claim is created based on the billing rules.
  • Medical Claims Audit: Audit for verifying the complete information and procedure.
  • Medical Claims Transmission: Creating claims before sending electronically to the claim transmission department.
  • Claims Submission to Insurance Agencies: Claims are ready to be dispatched to the concerned government department or insurance agency.
  • Follow up and Settlement: Billing organizations follow up reliably with payment agencies and insurers until the last settlement is made.

Therefore, medical claim billing follows up simple process of

Insurance verification – where the insurance is verified, patient’s demographic entry, ICD-10 and CPT coding, Charge entry, Claim Submission, Payment posting, A/R follow up, denial management and reporting.

In case you are confronting issue of soaring billing costs cost and spending more time in your billing practice than your patients, then outsource your prerequisites to the famous Medicare billing company – AccuretRCM.


Denial Management – Need in healthcare industry

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The importance of Denial Management cannot be ignored in a healthcare industry as the absence of it can lead to loss of good amount of collection. Every process of denial management carries a great importance for the medical billing company to increase the healthcare collections.

AccuretRCM recommends implementing Denial Management for carrying out the medical billing process. Some of the advantages of Denial Management are:

It avoids committing mistakes during claim submission

This goal can be achieved with a built-in claim validation procedure which includes payer-specific tests wherein these tests compare every claim with the regulation of Correct Coding Initiative. And diligently it assesses modifiers used for differentiating between procedures on the same claim, and compares the charged amount with allowed amount to avoid undercharging.

Identification of underpayments

The process of identifying the underpayments involves comparison of payment with the allowed amount. It also identifies the zero-paid items, and evaluates the payment timeliness. The effect of this stage can be displayed in a comprehensive underpayment report.

Appeal denials

Appeal management goes through certain stages which include prioritization of appeal, preparation of documentation and arguments, tracking and escalation. Here CCI provides justification basis for an appeal and every appeal must be argued on its own merits, which includes medical notes as well. Denial appeal process is further managed with a custom process tracking system.

Measurement of rate of denial

Measuring the denial rate is important as without measuring it the management will be difficult. It will highlight the modifications required in this process.