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Medical Claims Processing Every hospital receives many patients daily who demand urgent treatment and medicines. These medical facilities have different staffs that have different capabilities. For this reason, don’t be surprised when you check into a hospital and find that services are not similar to others. One thing that would make a medical facility to stand out in its operations is the manner in which it processes its medical claims. Unlike in the past, many people today have medical insurance covers to cater for their expenses whenever they fall sick. Whenever patients visit the hospital for treatment, they are sure that the insurance company will cater for such expense and it is, therefore, the duty of the health facility to claim the payment from an insurance company. These are revenues to the hospital, and it is important that there is proper processing of claims so that the payment is made as soon as possible. In processing the medical claim, two major processes are involved – coding and billing. Depending on a health facilities policies and financial strength, it can decide to employ separately medical claim billers and coders, or it can opt to employ persons who can do both billing and coding concurrently. Separating these jobs requires that the hospital spends a lot of money in paying the salaries as compared to when the jobs are done by a single individual who earns more than those who do a single task.
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The importance of coding in medical claims processing cannot be underestimated because patients who receive treatment in the facility have to be assigned unique codes. Coding must be done thoroughly to capture all the relevant information of the patient. An insurance company is most likely to deny the claim on the basis that the treatment was not medically necessary. Therefore, it calls for an expert who can do proper coding to this work so that it leads to a successful claim.
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After proper coding, the information is passed to the billing officer. This officer uses the information to fill a claim form electronically. Then, when he is sure that everything is correct, he forwards the forms electronically the insurance companies that are concerned. He must also make sure that he follows all the guidelines provided by the insurance company for claim submission. However, there are procedures that the biller must follow before making the submission. The acceptance or rejection of the claim form by the insurance company solely depends on how the processing was done. However, no human is perfect, and we are likely to commit errors that we did not intend to do; therefore, technology comes in to save the situation by the introduction of medical claim processing software. This software comes handy to help to process the insurance claims successfully. It saves a lot of processing time and does not have chances for errors. It is also cost effective because the health facility does not need to incur significant expenses in salaries as only a few individuals can operate it. They ensure that every detail matches and all the requirements are met. It also has a database of all the codes and procedures which a staff member can easily refer to whenever processing a claim. With this software, you can be sure to process medical claims without any hitches.