Basics of Medical Billing Software

Medical billing is an interaction between the healthcare provider and the insurance company. These two entities work together to process a patient claim. Your medical practice’s staff will update the patient’s records with medical billing software; these records contain the diagnosis information and the level treatments. The medical biller will then use medical billing software to inspect the medical record and translate this information to current procedural terminology code (ICD-9 and CPT code). A medical coder determines the suitable codes from the patient charts or medical history. This is the universal code used by insurance companies, clearinghouses, and healthcare providers. These codes are transferred to the insurance company where medical billing software is used to process and translate codes.

The insurance company processes the codes and then decides to approve or reject the claims. Most claims that are rejected are done so, because they have incorrect material or are in incorrect format. A rejected claim must then be resubmitted by the healthcare provider through medical billing software. The medical billing specialist also follows up on any unpaid or rejected insurance claims and resubmits as necessary.

Some medical billing software doesn’t output claims in HIPAA format. If this is the case, the software will rely on the clearinghouse to ensure that the data is accurate and converted to HIPAA compatible before reaching the insurance company. Software that doesn’t guarantee HIPAA compliance may mean lower FPA rates and ultimately, higher costs for your practice.

If you are looking to medical billing services, look to gather price quotes from medical billing software vendors and have questions ready to ask them about their systems, compatibility and other features.

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