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EBIO-EMR MEDICAL BILLING     PRESS ROOM

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What is medical billing?

Answer: Medical Billing Services; a process of submitting and following up on claims with the insurers to get imbursement for the healthcare practices that are delivered by a healthcare provider. Most insurance companies (either private domain or government sponsored programs) use the similar process. Medical Billing is basically an interaction between the insurance company and medical service providers. We can relate it with a provider-payer interaction process. This entire process is referred as Billing Cycle. The Billing Cycle is also known as Revenue Cycle Management as the services of Medical Billing effectively do the task of filling up claims and other managerial jobs to increase the revenue of Medicare providers.

The entire process of medical billing may take some time to complete. The process involves numerous interactions of Medicare providers and insurance companies to achieve a particular resolution. The medical billing process begins with an interaction between the physician and the staff of hospital to make a medical record of the patient. This medical record is constructed electronically with help of special software that is used to create and manage whole information of patient’s health. A medical record can be understood as a database in which the medical billers can add, update or delete the health information of a patient. It is generally consisting of the demographic information of patient like name, address, policy id etc and some other confidential data like summary of treatment, ePrescription, dieses, tests done, examination details and many more.

Then the medical biller fills up the claims and submits it to the insurance companies in order to receive the payment for the services provided by the doctor. Now the remedial administrator of the insurance company evaluates the claims to determine the legitimacy for the imbursement. After successful evaluation, the approved claims are then reimbursed to assure patients. The denied claims that are not found suitable for payment by the administrator are sent for reconsideration. The administrator does not process and simply rejects the claims that consist invalid data and are illegal.

The Medicare provider and the medical biller must have pure knowledge of the different insurance plans offered by insurance companies to be clear on payments. Also they should have sufficient knowledge about the procedure and the laws that preside over the insurance plans. When a claim is passed for the repayment then an agreement is signed by both the healthcare provider and insurer that include many details regarding the fee schedules and timely filing guidelines.