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How Medical Billing is Handled. Medical billing is the process where a healthcare provider submits documents requesting payment to the health insurance for the services rendered to one of their clients. Medical billing is conducted on all health insurance whether they are government sponsored programs or private companies. Medical coding includes all the details regarding the diagnosis and treatment of the patient. Health insurance has allowed many people to gain access to affordable healthcare in the United States. They have played a crucial role in changing the way healthcare is provided. For decades, the process of submitting these medical documents was done on raw paper. It involved faxing of copies of documents to and fro through the entire process. Time wastage was common before both parties came to an agreement. The evolution of technology has allowed for this process to be made entirely electronic. Technology like medical billing processing software has replaced the manual labor. The speed of EDI Billing has injected speed in filing these documents thus allowing parties to get to agreement fast. The new technology can handle a huge number of claim filing at once. It has allowed room for instant feedback and real-time update of data. People who identified the opportunities that come with these changes have managed to reap huge rewards. Software and technology companies realized the potential of medical claims processing and have done their utmost best to provide hospitals and insurance companies with the best solution. The software has also improved the communication channel between the transacting parties.
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As far as business opportunities are concerned, medical billing clearinghouse has been on the rise. These clearinghouses act as an intermediary whereas they help the hospital to submit the claim to the insurance company. Clearinghouses also conduct claim scrubbing which is checking for errors related to the claim. They also check to see if the claim is compatible with the software of the insurance provider.
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The process of filing a claim may take longer than anticipated, especially if the provider and the payer are both enrolled in different claims clearinghouse. If this is the case, then the claim will have to move from one clearinghouse to the next and may also be moving to and fro. It also means that the chances of your claim becoming stale or getting lost will also increase. It is always better to ask your claims clearinghouse where the claim will go after it leaves their office so as to avoid any unnecessary delays or loss of information and data.