Medical billing is a complicated procedure. Majority of the people does not understand what their medical bills say and what kind of services are covered under their medical bills. Once you have a thorough understanding of your medical bills and you know how to read them, the rest of the process becomes quite easy.
The Basics of Medical Bills
The process of medical billing starts when you visit a doctor or a physician. There are three types of documents you will need to understand:
Services Performed
You will be handed over a list of services performed by your physician or healthcare provider. This will be given to you once you leave the doctor’s office.
Cost of the services
The second information you will receive will contain a list of the services provided to you and their respective prices.
Explanation of benefits
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This is a document sent to the patient explaining the services healthcare insurer agreed to pay and the amount that is to be paid by the insured individual.
How to Read a Medical Bill
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- A typical medical bill consists of the patient’s full name and id number under the member’s information.
- The account number is the specific number provided to the patient by the healthcare provider.
- Provider name denotes the name of the physician/doctor or the healthcare provider.
- The claim number is the specific identification number provided by the insurer to the patient.
- Service codes explain the services that the patient has been provided by the healthcare provider. The total amount of each service given is also defined.
- Covered by the plan is the total amount covered by your healthcare insurance company.
- The amount under the heading of ‘not covered’ is the amount not covered by the insurer and Reason Code Description explains why this amount is not covered by the insurance company.
- Detailed information of the payment from insurance company to a healthcare provider is given under checks issued.
Analyzing your Medical Bill
Once you understand what is written on your medical bill, it is necessary to analyze it.
- There is a column of CPT codes against Services provided in a medical Bill. These codes represent all the services that a healthcare provider can offer.
- You should always double check the CPT codes for any error.
- To see if you are overcharged for a service, compare the cost of services on your medical bill to the cost of services provided in physician’s fee list on their website.
- You should always check the list of services offered on the medical bill to see if there is any additional service mentioned over there that you did not receive.
- Once you understand all the costs indicated on the bill, you can negotiate the cost of services with your healthcare provider.
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What is Medical Billing and Coding
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Medical Billing is the process of getting medical services from your healthcare provider, getting a bill based on the services performed and their costs, generating claims to get paid by the insurance company. Simple it may sound; medical billing is quite an intricate process since it involves the use of specific codes to electronically generate claims. Different insurance companies use different coding procedures. There are thousands of codes being used by insurance companies, and they keep changing. Therefore, there is a need for proper knowledge of these codes with a continued study of the new codes being created.
The understanding medical bill is necessary to well manage your health:
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If you an insured individual, but you do not understand the process of medical billing and the content of a medical bill, you will have to compromise a lot on your health. Once you know the basics of a medical bill, it will be easier for you to follow-up your insurance plan as well as negotiate with your healthcare provider and your insurer. Understanding the medical bill is an essential knowledge to avoid all sorts of errors and would help you arrange and save the amount for your future use. Understanding your medical billing process will also enable you to focus more on your health rather than worrying about the insurance procedure and payment of services performed. This is a great way to manage your overall health.
If you still find it challenging to manage your medical bills along with keeping your health as a priority, you can always consult companies providing medical billing services. These companies are well aware of the whole course of medical billing and coding and have hired experts to make responsible choices on your behalf.
