I have a shocking statement to share:
“Navigating the U.S. Health Care System is not easy due to complexities for both provider and patient”. On its surface the statement is simplistic, accurate, and defeating. There have been many articles written in the past about surprise patient bills from Emergency Departments and Out of Network Providers.
“Navigating the U.S. Health Care System is not easy due to complexities for both provider and patient”
However, the difficulties for the providers have been vastly overlooked. The average patient believes their provider knows more than they do when it comes the health care finances. This view may be true when it comes to understanding key terms like “deductible”, “copay”, and “coinsurance”. However, when it comes to answering questions like “why was this claim denied?”, “what is a clean claim?”, and “who do I talk to at the insurance company about my provider participation status?”; it can be daunting, leaving providers and patients alike to seek better information.
The average patient believes their provider knows more than they do when it comes the health care finances.
Medical billing has become more than sending a claim to the insurance payer. The medical billing department in the past was focused on sending out claims to the payers and receiving payment. It has evolved into understanding digital security, coding guidelines, and creating sustainable processes and practices. Though HIPAA has been around from the 1990’s, the focus went from standardizing electronic transactions to protecting confidential information. Those folks who work on your behalf in the Billing Function of Healthcare become your partner in compliance with HIPAA, CPT/ICD-10 coding, and reporting quality measures to health insurance payers.
A good billing team will know (or who to talk to at the health insurance payer) about what constitutes a “clean claim”, why a clean claim was not paid, and actively participate with compliance. Clean claims begin with a firm understanding how the health insurance policy works, and how the claim is submitted. If there is ever a question of how a claim was processed, then will the billing department can contact the health insurance payer to get clarification on the situation and plan next steps. Compliance takes the form of fiercelyprotecting passwords, physical and electronic information, and continuously improving in these areas.
A good billing team will help the health care provider receive the maximum reimbursement for the services performed and billed for. A great billing team will help the health care provider stay compliant with the various regulations, and partner to create a thriving sustainable business.
To learn more about our unique approach to creating a partnership with your practice, email us today to set up your free, no-obligation, introductory call. Let us put our 20 years of experience to work for you today!
info@q1stmdb.com
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