What is Medical Claims Processing and Billing?

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Title: What is Medical Claims Processing and Billing?

1
What is Medical Claims Processing and Billing?
www.mgsionline.com
2

Whether you are a new Provider or an established
healthcare practice, providing extra care to
the medical claim processing sector is the only
way to improve cash flow.
Although patient care is the key focus of
Physicians, many are new to the industry and lack
the experience to handle medical billing.
Well, it doesnt mean that experienced Providers
are well-versed in claims processing, as some of
them lack the latest technology software or
professionals skilled in the new healthcare
reforms.
In either case, outsourcing medical claims
billing is the best option! In order to learn why
it is the right solution, Providers should
understand how complex is the medical claims
processing and billing. This article emphasizes
just that

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3
What is Medical Claim Processing?

Then Providers render medical treatment to
patients, they get paid by sending out bills to
Insurance companies covering the medical
services.
It involves a lot of steps. Firstly, claims are
prepared by assigning specific ICD (used for
diagnoses) and CPT (used for treatment) codes to
the medical services provided.
These claims contain important information like
patient demographics and plan coverage details.
Then, the claims are submitted to the Payors.
The insurance companies evaluate each claim and
reimburse it accordingly.

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4
Medical Claim Billing in Depth

Medical claim processing is not as simple as a
walk in the park.
It is a complex task that can be carried out only
by skilled professionals who have great attention
to detail, immense training in the new coding
techniques, good communication skills, and
knowledge on current healthcare trends.
To be qualified by the Payors, claims have to go
through many technical protocols and pass
industry standards.
HIPAA is one such standard that ensures
high-level security during patient data
transmission.
Processed claims are filed electronically to
expedite the process and improve efficiency.

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5
Clearinghouses

The next step in medical claim billing is
clearinghouses to which processed claims are sent
to.
It is a third-party hub that operates between the
Provider and the Payor.
Clearinghouses sort out all claims, scrub them
for errors, format as per industry standards, and
send to various insurance carriers.

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6
Explanation of Benefits

After evaluating the claims, the insurance
companies reimburse the Providers or reject
erroneous claims if any.
They should also provide EOB (Explanation of
Benefits) to patients as well as Providers.
EOB is a statement that shows several details
like dates of treatment, diagnoses, charges,
Providers reimbursed amount, and patients
financial responsibility.

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7
Why Outsource?

Anything can go wrong in this huge, complex
process.
Therefore, the in-house billing team should
perform medical claim processing exceptionally
well and conduct multiple audits before filing
claims.
If the team is not competitive enough to handle,
then Providers can opt for outsourcing medical
claim billing.

www.mgsionline.com
8
About Us
www.mgsionline.com

If you are on the lookout for an
experienced medical billing company, then
consider MGSI, which has more than 20 years of
experience in the healthcare domain.
Based in Florida, this company possesses the
latest technologies and software solutions to
process claims without errors.
MGSI is A rated company with Better Business
Bureau.
To learn more details, log on to
www.mgsionline.com.