Medical Claims Processing Software
Daily, many patients check into health facilities in every part of the country in need of treatment and drugs for various illnesses. However, these hospitals have different qualities of services because they employ a labor force with different capabilities. Therefore, it not a surprise that health facilities do not offer equally quality services. One of the most crucial aspects of a health facility is how it goes about medical claims processing.
Unlike in the past, many people today have medical insurance covers to cater for their expenses whenever they fall sick. It is upon the medical facility to claims these amounts from the respective insurance companies of the client patients. These are revenues to the hospital, and it is important that there is proper processing of claims so that the payment is made as soon as possible.
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. However, those individuals that perform both duties earn more than those who do the jobs separately.
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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. Coding must be done thoroughly to capture all the relevant information of the patient. An insurance company is most likely to deny the claim on the basis that the treatment was not medically necessary. 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. The medical biller uses the codes to fill an insurance claim form. This process is not done on hard copies but in soft copies. An insurance company usually outlines certain procedures for filling the form that the facility must adhere to for a fruitful transaction. Therefore, depending on how the form is completed, the company may decide to reject or accept it. Depending on how billing is done, the company may reject or accept the medical claim payment.
Due to the sensitive nature and informational requirements in filling the forms, there is need to use Medical Billing software. This software is capable of performing all the tasks efficiently and accurately in a short time. It shortens the processing period, and it does not give room to errors which may lead to claim rejection. 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. The software is a relief to many facilities that may have lost revenues due to unsuccessful claims.