Medical Billing Made Easier
Medical Billing Made Easier
With Tri-County as your trusted ally, you can have peace of mind knowing that your financial health is in reliable hands. We warmly invite you to reach out for a consultation, as we are eager to discuss how our dedicated, personalized services can enhance your practice’s revenue generation and streamline your billing experience, allowing you to thrive in your mission to care for your patients.
Empowering Medical Professionals to Greater Efficiency
Empowering Medical Professionals to Greater Efficiency
It is important to have a thorough understanding of the different insurance companies and their policies in the healthcare industry. Each insurance company operates according to its own set of rules and regulations, which can have a significant impact on billing procedures. As a medical billing service provider, Tri-County Medical Billing Service understands the importance of this knowledge and is committed to enhancing our clients' knowledge to help them run their practices more efficiently.
Patient Registration
Patient Registration
This is the first step on any medical billing flowchart. Here, a patient’s information will be collected such as name, birthdate, and purpose for visit. Medical billers will collect and verify a patient’s insurance information, provider, and other details. This information will be used to set up a patient file for reference during the medical billing process.
Financial Responsibility
Financial Responsibility
The next step is to look over the patient’s insurance details to see which procedures and medical services are covered. If he or she needs a certain service but it is not covered, he or she will be informed to be financially responsible for the costs of this service.
Superbill Creation
Superbill Creation
The patient will fill out forms for their file. If it is a return visit, his or her information on file will be verified or updated. The patient must provide identification, a valid insurance card, and co-payments. Once he or she checks out, a medical coder translates the patient’s medical reports from his or her visit into procedure and diagnosis codes.
A report called “superbill” may be compiled based on all the information collected so far. It will include:
- Provider and Clinician Information
- Patient Demographic
- Patient Medical History
- Information on Procedures
- Information on Services Performed
- Applicable Diagnosis
- Applicable Procedure Codes
Claims Generation
Claims Generation
The medical biller will use the superbill for a claim which will be submitted to the patient’s insurance company. The biller will go over the claim to ensure it meets the payer, HIPAA-compliance, medical coding, and formatting standards.
Claims Submission
Claims Submission
Usually, the claim will be transferred electronically to a clearinghouse, a third party acting as a liaison between the insurers and healthcare providers. High-volume payers like Medicaid are an exception as they accept claims directly from healthcare providers.
Monitor Claim Adjudication
Monitor Claim Adjudication
This is when the claim may be accepted, denied, or rejected. If a claim is accepted, the insurer pays the claim according to its agreement with the provider. A rejected claim has errors that must be corrected for resubmission. If a claim is denied, it means the payer refuses to reimburse.
Patient Statement Preparation
Patient Statement Preparation
After the claim is processed, the patient will be billed for any outstanding charges. The statement will contain a list of procedures, services, their costs, insurance-paid amount, and patient amount due.
Statement Follow-Up
Statement Follow-Up
The last step is to ensure bills are paid. Medical billers will reach out to patients who still have outstanding balances. If necessary, billers will send accounts to collection agencies.
Understanding HIPAA Guidelines
Understanding HIPAA Guidelines
Whether you're a patient or provider, it's important to understand the ways the HIPAA policies and procedures impact the health care industry in the US. The HIPAA guidelines can provide patients with confidence in their privacy. Get to know your rights and responsibilities with HIPAA!
What is HIPAA?
What is HIPAA?
HIPAA is an acronym that stands for Health Insurance Portability and Accountability Act. This is a US law established in 1996 under President Bill Clinton. This law impacts the way health care providers and all businesses associated with the health care industry in the US, including health insurance providers, can share and must secure an individual's health care information.
Essentially, HIPAA is all about your privacy as a patient. The HIPAA rules are intended to govern the behavior of providers, insurers, and other health care professionals. But these rules impact patients as well. Chances are you have had to sign some confidentiality and record release forms upon establishing yourself as a patient at a new doctor's office, which is due to HIPAA.
HIPAA Security Rule
HIPAA Security Rule
HIPAA covers a few different areas relating to health care information. Security is one of the major areas HIPAA covers. According to the HIPAA security guidelines,
providers and other health care professionals must protect confidential patient records from theft and other incursions from unauthorized parties.
This covers both paper and digital records. Analog file cabinets must be locked, and digital databases must be password-protected. As a reputable medical billing company, Tri County Medical Billing Service follows the privacy and security rules very stringently.