In theory, medical billing seems like it would be just as simple and straightforward as any other billing process. In reality, however, medical billing can be a whole lot more complex, which is why medical facilities typically keep dedicated billing experts on their payroll.

Medical billing can get very complicated, depending on whether or not a patient has health insurance and what that health insurance actually covers.

It can get even more complicated when patients and insurance companies can’t agree on what should and should not be paid for after medical bills are sent out.

In general, the first step associated with the medical billing process involves determining what type of health insurance a person has and then billing their insurance company for whatever services were rendered during treatment.

• However, instead of simply sending a bill that, for example, says, “You owe $1,000 for this service,” medical providers must file specific claims using standardized forms when dealing with insurance companies.
• These forms require medical facilities to include a comprehensive list of information about a patient, their insurance plan and the special codes that are assigned to the relevant medical services.
• Claims must include any and all lab work, supplies, exams and other services offered during treatment.

Once the proper forms have been filled and sent to the insurer, the insurance company will then take a look at which services are covered under a patient’s plan and reimburse the medical facility accordingly.

• In most cases, there aren’t any problems, as long as the right medical billing procedures are followed.
• If there is a dispute over what’s covered and what isn’t, or if the claim forms aren’t submitted properly, the insurance company may put a hold on the payment. This can cause friction between patients, their insurers and health care facilities.
• Bringing a balance owed down to zero can be a challenge, which is why healthcare facilities need to have someone with medical billing experience on hand to deal with any unforeseen issues that might arise.

At CSS Impact, our receivables management system can help streamline the medical billing process and prevent costly billing errors. Request your demo today.