Every hospital receives many patients daily who demand urgent treatment and medicines. These medical facilities have different staffs that have different capabilities. So, it may not be surprising that you get better services in one particular facility than the other because they have varied employee capabilities. One thing that would make a medical facility to stand out in its operations is the manner in which it processes its medical claims.
Today, many patients have insurance covers for their medical bills. It is upon the medical facility to claims these amounts from the respective insurance companies of the client patients. To qualify for a claim, one of the requirements is that the claim processing must be complete with the right details.
The processing of medical claims undergoes two processes which are coding and billing. Therefore, some facilities can manage to hire medical billers and coders separately while others that have limited resources may want to employ professionals who can do both billing and coding. Separating these jobs requires that the hospital spends a lot of money in paying the salaries as compared to when the jobs are done by a single individual who earns more than those who do a single task.
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Coding comes first before billing, and it is the first step which involves coding of various patients who come to the facility for different reasons. An application may not be successful if coding is not properly done. An insurance company will not accept to make that payment to the facility without adequate information. Therefore, it is essential for a health facility to have a professional coder who is accurate and thorough in the job.
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The first part is coding and after that, the coder hands over the codes to a medical biller. Usually, the billing officer feeds the information into the computers. He must ensure that he fills all the required parts of the claim form and he submits it electronically to the insurance company. He must also make sure that he follows all the guidelines provided by the insurance company for claim submission. However, there are procedures that the biller must follow before making the submission. The acceptance or rejection of the claim form by the insurance company solely depends on how the processing was done.
Due to the sensitive nature and informational requirements in filling the forms, there is need to use Medical Billing software. This software comes handy to help to process the insurance claims successfully. This software completes the process much easier to save time, and it is not prone to errors. It is also cost effective because the health facility does not need to incur significant expenses in salaries as only a few individuals can operate it. They ensure that every detail matches and all the requirements are met. It also has a database of all the codes and procedures which a staff member can easily refer to whenever processing a claim. With this software, you can be sure to process medical claims without any hitches.