Healthcare is an integral part of our lives. Its availability and access are now considered as a fundamental human right in almost all countries. Hospitals are those institutions that ensure that. Whether you are injured or having a chronic decease, it is the responsibility of the hospital staff to take care of you and heal you. The hospital billing process is different in different countries. In the United States, the hospital billing process consists of three parties the patient, the hospital, and the insurance companies from which the patient has bought the health insurance. The primary purpose of this billing process is to get reimbursements from the health insurance company, either public or private, for the services rendered to the patient. For example, the medical billing services in NY are considered as the backbone of the financial systems of the hospitals there.
What is the billing process?
The hospital billing process starts with the registration of the patient after that the doctor examines and treats the patient. After the treatment diagnoses and procedure codes are assigned, these codes help the insurance companies to identify the amount of the claim they will have to reimburse. Once they are determined, the medical biller sends requests to the insurance company, which is now done electronically.
The insurance company then checks the credentials of the person insured in this step; the insurance company checks his identification and insurance plan. The insurance company makes sure that the person who took the treatment was the same who has purchased the health insurance, and his/her health insurance covers the procedure he/she received. After that, the approval stage comes in which the insurance company examines the claims made by the hospital; also, they check for over-billing and other discrepancies. Once the insurance company is satisfied, it passes the number of reimbursements, and the payment is made to the hospital. This whole process takes weeks and in some cases, months. Sometimes these claims are rejected due to errors adding to the cost hospital.
Due to exponential growth in the number of patients, now hospitals are using the services of companies called Medical Billing companies. These third-party companies provide medical billing services to hospitals. They cover all the billing stages of the hospital from patient data entry from reimbursement of its claims from the insurance companies. In New York, many hospitals are outsourcing their billing services to companies like MEDloop, Max Remind, and 5 Star Billing Services. These not only increased the reimbursements of the claims but also reduced the cost of paperwork of the hospitals. Now those hospitals that are using these billing companies are more efficient than those who are still thinking of switching to them.
If this cycle runs smoothly and efficiently, the hospital remains efficient and profitable. Now hospitals have started outsourcing this work to medical billing companies. These companies work as a middleman between hospitals and insurance companies. They manage the billing process and make sure that the hospital receives its claims of the services rendered.