Billing and Collections Services
Medical billing is the process of generating claims to submit to insurance companies for reimbursement of healthcare services.
Medical collections is the process of pursuing payment for unpaid patient balances and delinquent insurance claims.
Together, they form a crucial part of the healthcare revenue cycle.
The medical collections process begins when a medical bill is past due and involves pursuing payment from both insurance companies and patients.
The Medical Billing Process
Patient registration and data collection:
The process begins with collecting accurate patient and insurance information.
Medical coding:
Medical coders translate a patient's diagnosis, treatments, and services into standardized medical codes, which are used to generate the claim.
Claim submission:
The medical biller submits the coded claim to the patient's insurance company for reimbursement.
Payment posting:
Once the insurance company processes the claim, they send an Explanation of Benefits (EOB) statement detailing the portion of the bill they have paid and the patient's remaining responsibility.
Patient invoicing:
The provider's billing department then sends an invoice or statement to the patient for the remaining balance.
Collecting from Patients
Initial reminders: After a service is rendered, providers typically send the patient an invoice for their portion of the bill. If payment is not received, the provider sends several reminders over the next few months.
Following up on delinquent accounts: If a patient's bill remains unpaid after a set period, the medical biller follows up directly with the patient through further communications.
Using a collection agency: If the provider is unsuccessful in collecting the debt, they may send the account to a third-party collections agency. These agencies specialize in recovering debts and are required to follow rules set by the Fair Debt Collection Practices Act (FDCPA).
Negotiating payment plans: Providers or collection agencies may work with patients to establish a manageable payment plan.
Collecting from Insurers
Following up on denials: Billers must track outstanding balances and actively pursue payment from insurance companies for denied or underpaid claims.
Managing appeals: If a claim is denied, the billing department may need to file an appeal with the insurance company to challenge the decision.
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