Author: Sadam Manasa Leela*1
Abstract:
It can be exceedingly difficult to manage any practice’s medical billing duties in the modern, complicated healthcare sector. It is at this point that outsourcing medical billing is a practical choice. Making the switch to a paperless medical practice is crucial. All types of medical records are converted to digital format through the abstraction process.
Introduction:
Medical billing is the procedure through which healthcare professionals draught and submit claims to payers insurance companies to get payment for services rendered to patients. Many claims that are denied can be amended and challenged, including those that are refused due to incomplete or inaccurate data, duplicate or late submissions, incorrect or obsolete CPT or ICD-10 codes, a lack of supporting paperwork or prior authorization, among other reasons.
Despite the fact that medical billing operations were formerly carried out using paper-based techniques and handwritten or typewritten papers, the emergence of numerous technologies in the healthcare sector has converted it to an electronic process. This has eliminated human and administrative errors and saved time and money. [1]
Medical Billing Processes:
Medical billing is simply a process with eight straightforward steps, despite its size and apparent complexity. [2] These steps include;
            (  Fig 1: End-to-End Medical Billing Services )
Benefits of Medical Billing Software:
It is the 21st century, and writing documents with hands can be difficult. Using software instead of managing the details by hand with paper documents speeds up the entire process, and it is much easier looking and manage the documents. [5]
Fig 2:Â Benefits of Medical Billing Outsourcing
Medical Billing Insurance with respect to Insurance Company;
(STAR HEALTH)
On taking star health as a medical insurance company for medical billing. Regardless of even the smallest surgery or therapy, in-patient admissions in India end up being costly. When purchasing your health insurance, make sure you fully comprehend the terms of the policy. In this hectic environment, be ready to deal with health difficulties. Therefore, it is always advisable to take safeguards that would be useful in case of medical emergencies. According to experts, both forms of paying for hospitalization costs are acceptable, and having health insurance is a need. It is obvious that handling medical emergencies would be best done either cashless or through reimbursement.
 Cashless Facility:
When hospitalization is cashless, the health insurance company (the insurer) pays the network hospital directly for the insured person’s (the policyholder’s) medical care in accordance with the terms of the policy.
The hospital receives payment directly from the insurance provider for all emergency and planned hospitalizations at affiliated hospitals.
The necessary paperwork for the cashless request will be sent to Star via the hospital’s insurance desk’s Hospital Portal.
The insurance will pay the hospital’s cost after notifying that your request has been approved.
Reimbursement Claim;
A reimbursement claim is paying the hospital cost out-of-pocket before requesting reimbursement from the insurance provider.
The patient after the completion of treatment in the hospital. Patients or the representatives take the medical bills to the insurance company and the company after thoroughly checking the bills they ask the patient to pay the rest of the amount inspite of how much the hospital would bare according to the insurance policy of the patient.Â
Conclusion:
The phase of the doctor-patient relationship that is most crucial is the medical billing process. It guarantees that all expenses will be paid. Additionally, it aids in keeping track of your receivables and payables. The type of income gathered determines how much money successful medical billers or doctors make. This is only feasible if the medical billing procedure runs well. Only if it is flawless will the medical billing procedure be successful. This means that each stage in the procedure needs to be completed with adequate documentation and customer care.
References:
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