Author: Vani S
Vani S, Drugs Testing Laboratory, Drugs Control Department, Bangalore, Karnataka, India
Chandrasekar SB, Drugs Testing Laboratory, Drugs Control Department, Bangalore, Karnataka, India
The medical billing procedure involves series of stages by which billing specialists guarantee that medical professionals are reimbursed for their facilities. Depending upon the situations, it can proceeds a matter of days to complete, or may take several weeks or months. The process may slightly differ between medical establishments, but a general skeleton of a medical billing workflow pattern is as follow:
It is a common disbursement procedure in the United States medical management system but whereas in India most of them are Institutional billing. It starts with the process of obtaining insurance proof by healthcare provider from a patient, filing, subsequent follow-ups and then appealing with health insurance firms to accept payment for the services provided. For example: diagnostic tests, treatment given and other hospitalization processes. The process followed is same even if they are private establishments, insurance companies, government funded platforms. Medical cryptograph gives information about overall findings, treatment, processing fees, consultation and medical bills consequently.
Medical billing agencies remain cheered, nevertheless not compulsory by regulation, even then to turn out to be certified medical biller one can take an exam such as the CMRS Exam (Certified Medical Reimbursement Specialist Exam by Certifying Body of American Medical Billing Association), RHIA Examination (Registered Health Information Administrators by Mometrics Academy, US), CPB Exam (Certified Professional Biller exam by American Academy of Professional Coders) conducted by US etc.
Certification institutes are projected to deliver a theoretical basis for pupils ingoing the medical billing arena. Those looking for improvement could be cross-trained in auditing, transcription, coding along with a bachelor’s gradation in medicinal data discipline and expertise.
Even it’s not mandatory to possess a qualification to acquire billing knowledge, still most of the billing companies prefer a certification course. Certification however helps individuals to make mandate for most of the employment opportunities stand concerned. Such Billing process differs from state to state and country to country.
Steps involved in the Medical Billing Process
1. Patient Registering
2. Monetary Responsibility
3. Super bill Making
4. Dues Generation
5. Claims Submission
6. Monitor Due Adjudication
7. Patient Proclamation Preparation
8. Declaration Follow-Up
Main Steps involved in the Medical Claims Submission Process
Advantages of Medical Billing Process
Probabilities of medical care scams, imprecisions in the proposal of health entitlements and not abiding to prevailing Central, Municipal, state-owned and Financier guidelines, hard amenability necessities, newness by medical billing regulations etc. Following entire instructions as well as processes can propose an excellent quality output at reasonable amounts. Helps in improvising professional medicinal billing services en route for other medical management BPO, medicinal billing establishments and insurance firms.
Examples of best medical billing companies in India:
1. Knack Global
Knack Global is one of the fastest-growing medicinal billing companies in India having offices at 4 different situations in the USA and 2 offices in India at Chandigarh and Jaipur.
2. Omega Healthcare
Omega offers all processes related to revenue cycle management. They are mainly focusing on the fast settlement of claims which increases the cash flow. Omega Healthcare is located in Boca Raton, FL and has business centers in Mumbai, Pune, and Chennai.
3. Access Healthcare
Access Healthcare was started in 2011 and becomes one of the largest medical billing companies in India after acquiring Pacific BPO. They have 18 services centers across the USA and India.
4. Medusind Solution
Founded in 2002 Medusind Solution is providing onshore as well as offshore services. They are operating from various locations such as Orlando, Los Angeles, Oklahoma City, Miami and Fort Worth, Roanoke, New york in USA and Mumbai, Chennai, Ahmedabad, Coimbatore in India.
It provides over 15 different kinds of outsourcing services and medical billing is one of their specialties, having business centers in different countries like India, Colombia, Philippines & Bolivia.
6. Revenue Synergy
Revenue Synergy is a leading revenue cycle management and medical billing services, provider.
Certified courses/ exams in US:
Certified courses/ exams in India:
Henry Harvin, Med Pro American Health Care Solution, South Indian Medical Coding Academy, Elate Academy, Udemy, CIGMA Medical Coding Academy, Medesun Healthcare Solution, Apex Medcom, Acusis Medical coding in India, ASAP, Resolve etc.
Types of Medicinal Billing process
About two different kinds of medical billing in the healthcare sector exists, which are specialized billing (professional) and official billing (institutional).
1. Professional billing
Professional billing is also called physician billing or medical office billing. Professional billing specialists are regularly necessary to recognize both billing and the coding system.
Professional billing is in charge of billing entitlements produced by doctors, dealers and other non-institutional sellers for clinical and non – clinical treatments. It contain both in-patient and out-patient processes. However, procedures in the in-patient and out-patient sectors are billed only after insurance confirmation. This is due to the fact that only certain in-patient and out-patient processes may be invoiced for entitlements under the patient’s insurance treatment or insurance contract.
2. Institutional billing
The word institutional billing is also recognized as hospital billing. The facilities of expert nurses are also billed for entitlements under this billing procedure. Furthermore, hospital billing is used to bill declarations for medical facilities such as laboratory facilities, medical supplies and facilities and also radiology among other facilities. It is vital to remember that Institutional billing merely addresses the billing process and does not address medicinal coding. As a result, institutional billers are absolutely educated in billing and collection process.
Reasons for Differences between medical billing process in India and other countries:
Health management/ Preventive medicine in India are more reasonable when compared to health management in the USA. Even though there are many health insurance plans available in India, the majority of people cannot afford it. As the majority of the people are from weaker sections, health insurances are unaffordable. But whereas in the US, people have better access to many healthcare services.
Due to its economy, US people have improved access to simple facilities like clean drinking water, sanitation, health management systems etc. Whereas in India, having dense population where in majority of people are below poverty line, hence do not ensure proper access to basic facilities. According to the latest information, the US devotes 17% of its Gross Domestic Product to healthcare whereas India devotes only 4%.
The US mandates its citizens to have a valid health insurance policy and also employers should compulsorily provide medical insurance protection to all its personnel for the total period of occupation. Whereas, in India, it’s not mandatory and is optional.
The medical insurance policy in the USA covers most of the medicinal expenses experienced by the assured, whether it is doctor’s consultation fees, minor ailments such as diarrhea, flu etc. Whereas in India health insurance plans include the pre-hospitalization and post-hospitalization expenditures only.
The normal amount of premium in the US is greater than that of India. As the cost of living in the US is sophisticated when compared to India, the average premium in the US is also higher.
In the US, medical insurance policies are governed differently in different states; hence different types of health insurance plans are available for citizen’s choice. Whereas in India, health facilities are governed by the Central government, hence uniform throughout the country..
In the US, A proprietor affords medical insurance to entirely to its workers counting those who have acquiescent, until they get into another job. But in India health insurance are provided to current employees only.
Most Americans have health insurance plans; only 10-12 % of citizens pay from their own pockets. In contrast, 70% of the Indian population does not have health insurance and hence has to pay from own pockets.
In India, medical facilities are provided by both public and private institutions. Even though medical services are offered by the government for most of people, the quality of medical care given are very basic. The medical services provided by private institutions are far better and are highly expensive. In the US, regulations like Obamacare & the Patient Protection Act provide equal access to all its citizens.
Having a systematic medical billing process one can save money and time in reimbursing medical bills and can devote extra care to the patients.
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