For sure, everyone wants to live a healthy and peaceful life. But still there are times when you get sick or injured. The most vital thing everyone needs in difficult times like illness and injury is financial support to cover medical expenses.
Healthcare insurance is something really valuable that covers all your surgical, medical expenses, dental expenses, prescription drugs, etc. people having health care insurance are said to be as subscribers or insured and they need to pay a specific amount of money that is what saves them from further medical expenses.
Significance of Healthcare System
The healthcare system is quite an important part of the entire medical business all over the society. It consists of providing a broader range of services to all age group people. The system of healthcare makes sure that the medical services are meeting the demands and conditions of the patient. Recently, a lot of changes have happened in the medical field. Also, the healthcare system must get adapted to the technological advancements to look after the patients properly ensuring proper treatment is given to them.
With the growth in population, the significance of the healthcare system is also getting intensified specifically in times of global pandemic like one recently caused by Coronavirus. This tremendously pressurized the capacity and capability of the health institutions and healthcare providers. In the recent past, there has been rapid integration of innovation and technology in the healthcare system assuring the physical and mental health of people.
What Are The Types of Health Care?
The healthcare billing services has major role in the system of healthcare, which is further divided into three main categories that are;
- Primary Care: In this type, the health care provider serves the patient as his first contact and provides him with daily healthcare.
- Secondary Care: In this type the primary healthcare physician refers the patient to a specialist doctor or surgeon who is more knowledgeable and experienced about the health condition and symptoms of the patient.
- Tertiary Care: In this type the patient gets referred by both primary and secondary healthcare providers to a bigger medical center having advanced levels of facilities.
The Role of Medical Billing and Coding in the Health System
All over the United States, the health care providers gain particular compensation to provide medical services in the best way to all the patients. Those medical services are evaluating, diagnosing, and patient’s treatment.
Medical billing is the term that is the name of the process in which the health practitioners like nurses and doctors fill a form following the medical services that is particularly for patients to let them submit the claims to the insurance companies and payment probably will be received. Medical billing services include the conversion of health care services into a billing claim.
On the contrary, medical coding is the process in which medical services, equipment, medical procedure, and diagnosis gets changed into universal alphanumeric codes. A clinical coder is the one certified, qualified and professional person who checks on the clinical and medical statements assigning the codes in accordance with the classification system.
Both of these systems, coding and billing are pondered as the backbone of the entire healthcare revenue cycle assuring the healthcare provides their on-time compensation for the clinical and medical services they are giving to the patients. Codes are for helping the billing system make it accurate and efficient.
The process and diagnosis is to make the medical procedure effective or for tracking the disease speed all around. However, the main aim for coding companies and medical billing is for the reimbursement to the healthcare providers.
Reason Behind the Significance of Medical Bill
Whenever a person falls sick, going to the doctor only seems like one interaction between the doctor and patient. But in reality it is part of a big network of information that renders medical services and payments. For the completion of medical diagnosis and treatment is a process that includes three ways and steps. Those steps are;
- Healthcare providers that are clinics, hospitals, emergency rooms, physicians, physical therapists and outpatient facilities.
- Insurance payer or the company
The medical biller has the role for discussion and arrangement of proper payment in between these above mentioned three parties. The biller needs to give surety that the healthcare provider gets compensated properly for the services they are providing. The biller is assigned to collect the information regarding the patient and the entire medical process from the superbill that further gets compiled in the form of a bill for the insurance company. This is the point said to be as claimed.
These are the things that are included in patient’s claim;
- Medical history
- Demographic information
- Insurance coverage
- The medical procedures or services rendered are procedure codes and why that is diagnosis codes.
There are several types of health insurance in which some procedures and services get covered and some not. The medical biller is responsible for interpreting the insurance plan or coverage of the patient and using that information for the preparation of an accurate claim. A medical biller needs to use both the procedure and diagnosis codes that are given by the medical coders making the claim.
Also, a medical biller needs to assure that the claim is a complaint that means the information is correct on a factual basis. If the claim gets approved it is sent back to the biller with the amount needed to pay by the payer. Then, the biller takes the balance and sends that to the patient.
All in all, the cost of billing and coding services are different and vary among companies. However, most of those are determined on setup fees, total claims submitted, collection fee and monthly fee. Each of the medical services make uses of any software or AI tool for such billing management.