Description
After making an appointment, providing information about our medical insurer, and paying a token amount called a copay, rarely do we give a second thought on how practitioners, hospitals, and others in the healthcare industry get paid. Our copay is a fraction of the total cost of our visit. Medical insurers pay the bulk of our medical costs—but not before our healthcare provider submits an insurance claim along with supporting documents to justify the treatment we received during the visit.
Only if the claim is approved will the healthcare provider get paid. This appears to be a well-oiled efficient system for covering medical expenses. At least that’s true from the patient’s perspective. It can be a nightmare for a healthcare provider who cares for hundreds of patients daily with each having a different medical coverage and requiring a different treatment. Imagine trying to assemble a detailed bill with different supporting documents for each of the hundreds of patients treated by a healthcare provider every day—and tomorrow there are another hundred patients arriving. Your healthcare provider can easily be in a financial bind if there isn’t a constant, dependable stream of reimbursements from insurers. Your healthcare provider pays the cost of the medical and administrative staff, rent, utilities, and vendors who provided medical supplies and pharmaceuticals used to treat you. These expenses are paid before your healthcare provider is reimbursed by the medical insurer for your visit. Reimbursements stop flowing when insurers deny claims or delay processing them, and many times this is caused by medical billing and coding errors. Honest— and sometimes dumb—mistakes cause insurers to withhold reimbursements until the healthcare provider submits a correct claim.
Healthcare providers are on a financial tightrope balanced only by the stream of insurance reimbursements. They are trained to care for patients—not to navigate the maze of insurance rules and regulations. Healthcare providers rely on medical insurance specialists who know how to prepare claims and supporting documents to ensure that medical insurers approve claims—and keep reimbursements flowing.
The medical insurance specialists must:
– Thoroughly understand healthcare economics
– Understand the ethical and legal aspects of healthcare and insurance
– Be well versed in medical terminology and procedures
– Know medical office procedures
– Master procedure coding
– Grasp the details of medical insurance plans
– Take command of the insurance claim cycle
– Skillfully handle claims disputes
– Be a whiz at using medical management computer software
– And much more
This can be overwhelming but doable because there are proven techniques that medical insurance specialists use every day to tackle what seem like insurmountable problems. Medical Billing and Coding Demystified shows you those techniques and how to apply them in real-life clinical situations.
You might be a little apprehensive to pursue a medical insurance specialist’s position. Medical billing and coding can be mystifying; however, it will become demystified as you read this book. By the end of this book you’ll be able to step up to a medical insurance specialist’s responsibilities and begin to solve practically any problem that comes your way.