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How Medical Billing is Handled. Medical billing is the process where a healthcare provider submits documents requesting payment to the health insurance for the services rendered to one of their clients. The process is carried out in all insurance companies, whether public or private. Medical coding is used to entail what the diagnosis was all about and the cost of the treatment conducted. The insurance companies have provided people with a chance of accessing quality and affordable healthcare across the country. They have had a positive impact on the way healthcare is provided in the country. For decades, the process of submitting these medical documents was done on raw paper. It involved faxing of copies of documents to and fro through the entire process. Before a resolution was reached by both parties, it took a long time. However, with recent changes in technology, this process has been made electronic. Technology like medical billing processing software has replaced the manual labor. The EDI billing as they are known, have managed to make the entire process fast and has allowed for both parties to reach an agreement fast. The new technology can handle a huge number of claim filing at once. Feedback is now received and sent very fast and data can be updated instantly. People who identified the opportunities that come with these changes have managed to reap huge rewards. Technology companies have also played their part in providing hospitals and insurance companies with the best software to fit their needs. The software has also improved the communication channel between the transacting parties.
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These changes have also brought about the birth of medical billing clearinghouse. The main function of these clearinghouses is to act as intermediaries where they forward the medical claim from the hospital to the insurance firm. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also double check to ensure that the hospital’s claim is compatible with the health insurance’s claims processing software.
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The entire process might take a long time, and it is further complicated in case both parties are enrolled in different clearinghouses. This means that the claim will be forwarded from one clearinghouse to the next and the process might go to and fro. The process means that there are higher chances of the claim getting lost and falling into the wrong hands. It is always better to ask your claims clearinghouse where the claim will go after it leaves their office so as to avoid any unnecessary delays or loss of information and data.