Era of Advancement:- Medical Billing Process

READ ORIGINAL ARTICLE

?

KEYWORDS:

Healthcare system, ICD code-10, Claims, Insurance, IRDAI, Medical coders.

?

CONTENTS:

• MEDICAL BILLING
• MEDICAL CODING
• LOGISTIC OF BILLING
• SIGNIFICANCE
• HINDRANCE
• INDIAN SCENARIO
• GLOBAL SCENARIO
• FUTURE PROSPECT

?

INTRODUCTION:

Medical billing is the way of delivering health care claims, which are provided to insurance companies for gaining pay for the medical services provided by the organization.

The medical coders usually extract the billable information and translate them into standardized code which is further passed down to the medical biller and then made into bills and claims which translate, the health care services into medical billing claims to get the reimbursement for the health care services provided.

JOB OF MEDICAL BILLER:

The medical biller interprets the insurance coverage of patients and prepares the accurate claim. The diagnosis and procedure codes prepared by the medical coder both are used in the claim. The codes are of two types:

1. PROCEDURE CODE: This gives service information to payers like CPT [CURRENT PROCEDURAL TERMINOLOGY] and HCPCS [health care common procedure coding system].
2. DIAGNOSIS CODE: These are the code that medical necessity like ICD [international classification of disease].

When we talk about medical billing, medical coding always comes into the picture.

?

MEDICAL CODING:

It is part of medical billing, where the medical coder provides codes from the surgical procedure and carry out medical chart audits when the claim is denied. “Medical coding and medical billing are the backbones of the health care system. It makes sure repayment of the services that is provided by healthcare to patients.”

LOGISTICS OF BILLING:

The medical process is a complex process and faces challenges in the healthcare domain. Each step has its own significance and is to be performed by specialists efficiently.

The billing process follows this flow:

1. Patient demographic entry: It includes personal details of the patient along with “place of service” and date of service with patient insurance credentials are recorded, verified, and processed.
2. Secure Registration:?The patient sets an appointment with the physician it is effective if it is preregistered.
3. Retrieval and checking of medical claims: The staff takes information from the FIP service and then looks for any missing information in given documents any errors are notified immediately and rechecked the documents.
4. Medical Coding: An significant step in claiming process in this procedure and diagnosis codes are fixed by medical coders for patients based on CPT (central procedural terminology) and internal classification of disease[ICD -10] standards. It is based on medical diagnoses made by doctors.
5. Charge entry/creation: Once documents get checked and verified it moves into the main patient record it is before claims are made from the insurance company. The medical billing company claim insurance once entered and
6. Medical claim Audit: The claims undergo multiple checking and audit session. They are checked again for correct and complete information with producers and diagnosis codes, then a complete claim is submitted so there is no chance of rejection.
7. Claim Transmission: Claims with accurate coding through electronic data interchange (EDI) is conveyed to insurance complaints. The claim without any glitch is to be sent to the insurance company.
8. Claim submission: Audited and recorded medical claims are then printed and forwarded to insurance companies and government departments.
9. AR calling: It is called accounts receivable caller. This a very important step in the billing process. They ensure increased payment and lesser denials.
10. Denial Management:?This system make sure revenue growth in profit by decreasing rejections of the insurance companies. They make sure to analyze and research claims. So it lessens the chance of denial and reimbursement is maximum.
11. Payment posting: Final step is to propose payment to patients. They also explain benefits and electronic remittance advice to patients.

?

SIGNIFICANCE OF THE BILLING PROCESS:????????????????????????

Traditionally the billing process was done on paper and was manually entered, but now it is done by means of computers and medical billing applications which has made a large impact from the past to till date and can be done by using more advanced technology in the future. The significance of medical billing by using computer –

• Saves time and workflow without burdening medical staff.
• Errors can be minimized and claims are processed at a higher rate and rejections of reduced.
• It ensures that healthcare providers are able to receive fair and timely compensation for the care they provide to their patients.
• It ensures the accuracy and completeness of patient medical records.
• They make sure proper billing service by careful documentation coding of patient diagnosis, treatment, and other information.
• The overall support that is finical stability and quality of care provided by healthcare organizations.

HURDLES OF MEDICAL BILLING:

1. Patient’s Education:?Patients owe more for their healthcare services and having proper education about medical billing can ease the workflow.
2. On-time payments:?It is difficult when the patient and insurance company doesn’t make payment in a timely fashion. It greatly affects the process.
3. Inaccurate coding and Documentation:?For clear claims, medical billing specialists must have accurate demographic information patients, which can uptick in claims denial by insurance companies. So, updating healthcare organizations should be done regularly.
4. Missing Information:?Neglecting necessary information like date of birth, date of injury, and type of injury can lead to a denial from the insurance company.
5. Revenue loss:?It can be because of many factors. Revenue loss can be due to common errors and mistakes.
6. Tracking and Resubmitting Denials:?Based on estimation, 5% of all claims are denied and 50% of denied claims are never resubmitted. But monitoring these denials and resubmitting of claims in time consuming and complex.
7. Collecting balances from patients:?Pending balance collection from patients’ needs communication which is time-consuming and can become a hurdle in the billing and claiming process. It can be handled by asking payers for opting various payment methods.
8. Technology use:?Technology gives multiple ways to pay through digital transactions. The usage of advanced medical software can increase the flow of payment. Automating steps in the billing process can integrate administrative workflow.

INDIAN SCENARIO OF MEDICAL BILLING PROCESS:

In the Indian scenario of the medical billing process is done in two ways, one through cash payment and the other through health insurance. According to the Insurance Regulatory and Development Authority of India [IRDAI] total out-of-pocket medical expenses are nearly 62% of total healthcare costs in India.

• According to estimation, 90% of Indians do not have health insurance and medical expenses are spent through savings and the income of an individual on whom the whole family is dependent.
• In India, the overall spending on other expenditures is more than health care expenses.
• To the estimation done in the year 2008, the healthcare expenditure in India is of 1.3% gross domestic product (GDP) and in the year 2016-2017, it is 1.4% which is just marginal growth. From the above figure, it is evident that most of the people spend their savings and income on medicine that is 52%

Facilities by Government:

The insurance coverage available to Indians is provided by the government at a low cost through schemes like “Ayushman Bharat”.

The expenses of treatment are lower than that of other countries.

The claims submission are done manually or electronically and it takes a lot of manpower.

Responsibilities of patients:

If the person carries healthcare insurance they may not require to pay through their pockets.

CONCLUSION:

From the above, we can conclude that the lack of a proper medical billing system is needed to be established with proper knowledge of healthcare expenditure. Improving the infrastructure of the healthcare system and also making people aware of the importance of the healthcare system and encouraging people for making their career in medical billing and coding process.

?GLOBAL BILLING SYSTEM:

In countries like the United Kingdom, United State the individual spends only about 20% of cash on health care families. The insurance coverage is usually provided by private insurance than the government. The billing process in the U.S. is not the doctor’s responsibility. The insurance doesn’t cover all the treatments and procedures. The process of submitting and processing claims is done electronically and patients are often responsible for paying part of their medical bills.

?

COMPARISONS OF COUNTRIES BASED ON THE APPLICATION OF ICD CODE -10:

Canada:?When Canada implemented ICD code 10 it failed as the healthcare system neglected the following:

• The codes were different for crosswalks and mapping.
• Decreased productivity.
• Documentation issues (lack of knowledge of physicians).
• Learning new codes by coders.

Conclusion:

Underestimation of serious things can be risky. ICD code 10 in Canada did not change coding practice.

India:?When India implemented ICD code 10 in October 2015 it brought significant improvement in patient care.

• It also increased physician billing accuracy.
• Also enhanced clinical performance.

Australia:?Australia started using ICD-10 to report mortality rates in 1994.

• It is evaluated before implementation.
• Sustainability and code were better than ICD-9.
• An initiative of introducing educational courses about codes.

Conclusion:

Having proper information for providers, and patients have led to successful implementation.

FUTURE PROSPECTS OF MEDICAL BILLING IN INDIA:

Medical billing in India has a great future as it is the pub of many uprising services. According to the bureau of labor and statistics the medical field is expected to grow 15% from now to 2024. As technology will be advancing the medical billing process will also be advancing in a positive way. As the implementation of artificial intelligence in the medical billing process it is going to ensure a secure process, no leak of information, and can also give the ultimate joy of error-free data.

MY OPINION:

India needs to take steps to improve its infrastructure. And education about medical billing is an effective measure to be taken for improvement. Encouraging individuals to establish themselves in the field and also improving the insurance claiming system. Making people aware of the government schemes related to insurance and investing in them can increase life expectancy and make India reach the goal of?“DIGITAL BHARAT”.

CONCLUSION:

Overall we can conclude medical billing process is a complex and time-consuming one. To establish oneself in this field, one has to be skilled, and knowledgeable.

?

REFERENCES:

https://www.collaboratemd.com/blog/the-top-10-challenges-associated-with-medical-billing/

https://www.aapc.com/medical-billing/medical-billing.aspx

https://www.business.com/articles/medical-billing-process/

https://www.tempdev.com/blog/2021/10/02/8-biggest-medical-billing-challenges/

https://www.planstreetinc.com/challenges-and-opportunities-for-the-medical-billing-industry/

https://revcycleintelligence.com/features/exploring-the-fundamentals-of-medical-billing-and-coding