Electronic medical billing is the process of the submitting claims to insurance companies by electronic means and following up on them for the purpose of receiving payment for services provided by a health care professional. The process used is similar for most insurance companies regardless of the fact of whether they are privately owned or administered by the government.
The billing process has been described as an interaction between a health care provider and the payer, or the insurance company. It begins when a policy holder visits a health care provider’s office. A record of the visit will then be created or added to the existing files on that particular person.
Once the one seeking health care has left the office the data in the file that pertains to him, or her, is then used to determine the services to be billed to the insurance company. A claim is then submitted either manually or through electronic means, a paperless procedure that often speeds up the process.
Once the claim is received by the insurance company it is checked by a medical claims examiners, medical claims adjusters, or medical directors for its validity. When the claim has been determined to be valid the claims are reimbursed for an agreed upon percentage of the services that have been billed for. If, on the other hand, the claim is rejected due to a failure of some sort the provider that submitted the claim will be sent a notification to that fact.
If a notice that is a rejection of the claim has been received then corrections must be made to the claim by the health care provider and then resubmitted. This exchange of claims and their rejections may be repeated many times until it has been paid in full or the health care provider agrees to accept a payment that is incomplete.
The means to accomplish the medical billing process in a way that is electronic is what is called electronic medical billing. The time that had been taken up through the billing process and the processing of a claim is much reduced in comparison to more conventional methods.
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