The claim submission process in medical billing is one of the most important steps in ensuring that a healthcare provider is properly paid for the services rendered. It is critical that healthcare professionals understand the process in order to ensure that claims are submitted correctly and quickly.

From beginning to end, this article will discuss the medical claim submission process in detail and provide tips on how to ensure a successful submission.

What is the Claim Submission Process in Medical Billing?

If you have ever ran a small medical practice, you know how important medical billing can be. As medical bills pile up, understanding the claim submission process becomes increasingly important.

The insurance claims process is the completion and delivery of an itemized bill to the health insurance company. This document must include all the necessary information such as insurance members, date of service, procedure codes, and medical codes and must be sent to the insurance company for payment.

For healthcare providers, the claim submission process must be handled with care. Mistakes in the submission process can lead to processing delays or even declines from the patient’s insurance provider, resulting in less revenue for your practice.

In order to ensure you are getting paid as much as possible, it is important to ensure that all documents and codes are properly completed and submitted.

In addition to making sure the claim is accurate and free of medical coding errors, the submission process also requires that you are abiding by the specific billing policies of each insurance company.

Each company may have different requirements for submitting a claim, and can even change the requirements for submission depending on the type of service that was performed.

With that being said, let’s explore the role an outsourced service can play in helping you navigate the claim submission process in medical billing.

How Does A Medical Billing Service Handle The Claim Submission Process?

Running a small medical practice requires a lot of knowledge, hard work, and organization. Not only do you need to keep track of patient records, diagnoses, and treatments, but you also have to manage the financial side of things – billing insurance companies, handling payments, etc.

This is why many medical practices choose to outsource their billing to specialized medical billing services.

When you use a medical billing service, they handle the entire medical claims process, from submitting claims to insurance companies to handling denials and making sure you get paid properly. But how exactly do medical billing services handle the claim submission process?

1.  Claim Preparation

Before a medical billing service submits a claim to an insurance company, they must first collect patient information, including name, birthdate, and insurance information. They then obtain the necessary clinical data from the medical practice, such as the diagnoses codes and CPT codes related to the services provided. All of this information is used to properly prepare the claim for submission.

2.  Claim Submission

Once the claim is prepared, the medical billing service will then submit it to the insurance company. The billing service must choose the correct electronic format so that the claim is accepted by the insurance company. Additionally, they must properly format the claim according to the requirements of the insurance company.

3.  Claim Follow-Up

After submitting the claim, the medical billing service will follow-up with the insurance company to make sure it was properly received and is being processed. If there are any discrepancies or denials, the billing service will help address them, negotiate with the insurance company, and make sure that the claim is processed in a timely manner.

4.  Payment Posting

Once the claim is processed and accepted by the insurance company, the medical billing service will post the payments to the patient’s account and ensure that the medical practice is reimbursed properly. Additionally, the billing service can issue refunds to the patient for any overpayments.

5.  Managing Claim Denials

Unfortunately, some claims will be denied by the insurance company. When this happens, the medical billing service can help by appealing the decision and working with the insurance company to resolve the issue.

PMN

Choosing the right medical billing service is the key to a successful medical practice. By partnering with a professional medical billing service, you can be sure that claims are submitted and processed properly, so you can focus on what you do best – taking care of your patients.

Fortunately, with the help of PMN, you can take advantage of the latest technologies and automation to accurately and quickly submit claims on behalf of your patients.

In addition, PMN’s team of experienced medical billing professionals will provide detailed reporting on your claims and help you analyze trends in your practice to improve your business’s profitability.

They offer white-glove support to ensure smooth claim processing and can even act as a liaison between you and insurance companies or other parties involved in the claims process.

For more information, get in touch with the helpful staff over at PMN! Call them at (949) 215-5055 or visit their office in Laguna Hills, Orange County, California!

FAQs

Pros & Cons When Outsourcing Medical Billing To A Professional Service

The primary advantage of outsourcing your medical billing process is the time and money saved by allowing a professional service to manage all of the billing and coding. This can help reduce overhead costs and help practices focus on patient care.

Additionally, these services also have expertise in complex coding and know the regulations governing medical billing, so they can help ensure accurate billing.

Despite this, it will require a financial commitment, which can be a strain on a practice’s budget.

Common Pitfalls In The Claim Submission Process In Medical Billing

Firstly, it is important that all patient information is accurate and up-to-date. This includes the patient’s name, address, insurance information, and any other pertinent data. Even a single typo or missing piece of information can lead to a claim’s rejection.

Another common pitfall is incorrect coding which can lead to delayed payments, or even a denial of the services provided. This can be particularly problematic if the coding is not corrected in a timely manner, resulting in costly mistakes.