Effective strategy working out!

People from US normally acquire their medical insurance through their employer. An employer /company signs up for a particular health insurance plan, offers the plan to its employee and allows the employee to decide whether he/she wants to sign up. (Most employees do sign up and its often one of the firs

The role, structure and functions

How medical Insurance works

Types of medical insurance

 

 

WHAT IS MEDICAL BILLING?

  • This business seems to be no more than data entry and that the software makes the business work. And clients just waiting for someone to process their electronic claims..

  • WHAT IS MEDICAL CODING?

    Medical Coding is the process of converting verbal diagnosis and procedures to a standardized Universal numerical code. The details of the Medical diagnosis and procedures...

  • MEDICAL BILLING CLASSES

    The Medical Billing industry is one of the fastest growing industries in the market. In the Global market the Medical billing has shown a tremendous upsweep in the last few years...

MEDICAL BILLING FUNCTION

People from US normally acquire their medical insurance through their employer. An employer /company signs up for a particular health insurance plan..

ACCOUNT RECEIVABLE

 

We know that cash group enters the payments against the charge for which the payment was received.

If a payment is not received within appx. 30 days, AR function begins. AR‘s responsibility is to maximize the amount of money flowing into our company from the insurance companies. They do so by checking the insurance host system or by placing phone calls to the various insurance companies to discover why we have not yet received a payment for a particular charge or why the payment flow and tries to eliminate any loopholes in the payment flow.


They need to coordinate with both the charge and cash department for getting details how much charge sheet they received and they need to verify the charge sheet for more clarification like validity of card copy, do-payments, plans, financial class, etc.

Also from cash department to get the info like denials EOB, etc.


FINANCIAL CLASSES


Are used to track categories of patient for reporting purposes .The ARR will show how much income was generated by each class, as well as the outstanding receivables for each class.


Example of financial class:


M-Medicare                                         W-worker Comp                      T-travelers
I-insurance                                           S-self pays                               A –Avmed
P-Prucare                                             D-Medicaid

They need to run the different kind of report like 

1.Aged Accounts Receivable Report

2.Detailed Accounts Receivable Report

3.Collection Report