What is Medical Claims Processing and Billing? - PowerPoint PPT Presentation

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What is Medical Claims Processing and Billing?


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Title: What is Medical Claims Processing and Billing?

What is Medical Claims Processing and Billing?
  • 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
  • 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

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
  • 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.

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
  • Processed claims are filed electronically to
    expedite the process and improve efficiency.

  • The next step in medical claim billing is
    clearinghouses to which processed claims are sent
  • 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.

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.

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

About Us
  • 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
  • To learn more details, log on to

  • Do you have any questions?
  • Mail Us info_at_mgsinlne.com
  • Call Us 1 877-896-6474
  • Visit www.mgsionline.com
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