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MEDICAL BILLING

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					MEDICAL BILLING

BY ELIZABETH TOJO

DEFINITION

MEDICAL BILLING IS A PROCESS OF SUBMISSION OF BILLS TO THE INSURANCE COMPANY IN A

SPECIFIED FORMAT FOR THE SERVICE RENDERED
BY THE PHYSICIAN ON THE PATIENT.

3 MAIN PARTIES
PATIENT

PROVIDER

BILLING OFFICE

CLEARING HOUSE

INSURANCE COMPANY

BILLING OFFICE

RESPONSIBILITIES OF A BO
CODING MAINTAINING PATIENT REOCRDS AND ACCOUNTS FILING CLAIMS TO THE INSURANCE COMPANY FOLLOWING UP WITH THE INS CO & THE PATIENTS ASSURING HIGH PRODUCTIVITY & REIMBURSEMENT STRICT ADHERENCE TO THE RULES & REGULATIONS OF THE INSURANCE COMPANIES

DEPARTMENTS IN A BO
PRINTING

CODING
PRE-VERIFICATION CHARGE ENTRY

AUDIT / QUALITY CONTROL
CLAIMS & TRANSMISSIONS CASH POSTING ACOUNTS RECEIVABLES

COMPLIANCES

INSURANCE COMPANIES
THERE ARE TWO KINDS OF INSURANCE COMPANIES. THEY ARE :  FEDERAL INSURANCE COMPANIES  COMMERCIAL INSURANCE COMPANIES

FEDERAL INSURANCE COMPANIES
•GOVERNMENT INSURANCE COMPANIES •MOTIVE IS WELFARE •EXAMPLES :     MEDICARE MEDICAID CHAMPUS CHAMPVA

COMMERCIAL INSURANCE COMPANIES
•PRIVATE INSURANCE COMPANIES •MOTIVE IS PROFIT •EXAMPLES:    AETNA CIGNA BCBS

THANK YOU


				
DOCUMENT INFO
Karna Karna Healthcare Revenue Specialist http://medicalbillingonline.blogspot.com/
About A seasoned professional with more than 10 years of handful experience in the Medical Billing vertical of the US Healthcare BPO Industry. Began my career in the Voice Process and have spent a major part of it in Accounts Receivable, especially AR Calling, but have also gained valuable experience in other processes like Charge Entry, Payment Posting, Denials Management, Credentialing, Appointment Scheduling etc. Have performed the role of training and managing the staff of the entire Call Center in three companies. Have been taking care of Client Relations for the past 7 years in all the Projects I've worked for. Have lead many number of Teleconferences with several Clients and have worked closely with many of them even during their offshore visits. Have also played significant roles in the Business Development and Offsite Transition & Migration of new projects. Have grown in this industry by the different levels of hierarchy and excelled in every level.