Published on April 08, 2008.
If you’ve been to a doctor, you know how crazy things can get with the billing even if you have insurance. In this article, we seek to explain how this maze of red tape works.
Simply put, medical billing involves a series of communications between a doctor’s office and a medical insurer. What is medical billing used for? As you sit atop that cold steel table awaiting your prognosis, your doctor’s office is engaging in a dialogue with your current insurance company. The topic of conversation? You, of course. As your doctor checks for all your vital signs, various medical codes are placed next to your personal medical information contained within your file.
Once your doctor leaves the examination room, your file then goes into the hands of a medical secretary, and it is sent electronically to your insurance provider using the codes mentioned above. Once your insurer has your medical information, they then begin to check your policy in order to make sure that your claim is valid. If you are covered insurance wise, your insurer will then pay the claim. If not, your medical request will be rejected.
As a matter of fact, medical claims are rejected nearly 50% of the time. In most cases, a lack of adequate communication between your doctor’s staff and the insurance company is to blame. Most of the time, a medical provider will have to contact an insurance company more than once in order to make a claim. Codes can become crossed, and medical diagnoses may be overly complicated causing a bit of a problem. What is medical billing used for when it comes to government medical programs?
Whether you have a private or governmental insurance provider, medical billing remains the same. No matter what sort of coverage you currently have, there must be some form of consultation between an insurance provider and a medical facility. It is interesting to note just how many claims are filed every day within the United States (millions), and how many people actually know what a medical claim consists of (hundreds).
Now that you are able to answer the original question (what is medical billing?), you have a better understanding of how insurance companies work. The next time that you visit your doctor’s office, think about all the different types of interactions that are occurring at that very moment. Medical billing may not be the most intriguing subject, but it does effect nearly every person that’s ever made a doctor’s appointment.
Yes, your doctor can expect 50% of his claims to get rejected. That’s because medical billing is incredibly complex. If your doctor has to follow-up or resubmit claims, he is asking staff to do double work. He is also asking them to get it right the second, third or fourth time.
If your doctor is contracting out his medical billing, he doesn’t have to worry about it. He doesn’t have to fight with insurance companies, resubmit claims or wait 60-plus days to get paid. he is running his office more efficiently.
Ask your doctor if he is contracting out his billing. If so, he is using a more efficient strategy than trying to run his billing in-house. Full disclosure…I’ve had doctors as clients since 2000. Here’s info about a service I feel all doctors should use.
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Mark Anthony Germanos serves as the Social Media Manager for MyMDSolutions.net, a Roseville, California based medical billing company that provides outsourced medical billing services for doctors’ offices. When doctors outsource their medical billing services to MyMDSolutions.net, they can increase doctor office revenue, employ modern-day medical software and use one of the few doctor medical billing companies that is ready for the upcoming ICD-10 coding mandates starting January 1, 2013. Although there are other medical billing companies out there, MyMDSolutions.net is uniquely able to improve your medical billing, increase doctor office revenue, provide doctor medical billing software, arrange equipment financing, streamline your insurance and increase your profits. Call MyMDSolutions.net today at (866) 976-1011 to have us analyze any 15 denied claims. We will collect on them at no cost to you.
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