Problems in Medical Professions and Their Solutions - Newport Paper House


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Problems in Medical Professions and Their Solutions

Medical practices has a large responsibility on their shoulder to balance patient care with high risk. Also along with that, they have to handle the administrative tasks. The medical profession is a noble. The medical profession is as a service to man is service to God. Medical professionals like a doctor have not only to deal with the patient's care but also bundles of expectation of his/her relative’s emotions.

These problems are not happening nowadays, its old story. The origin of medical billing lies in the USA.  For that, there is a concept of medical billing company.  We can say that medical billing companies reduce the tension between doctors and patients both.

Doctors’ first priority is their patients. But we can’t forget that doctors have their own personal life where they have to deal with infrastructure maintenance, service staff payments, and their personal health problem.

Medical billing companies are just like insurance companies. It is payment practice which follows healthcare providers and appealed claims with health insurance in order to receive payments for testing, treating, and procedures. Medical billing should be included in syllabus. Their courses are not compulsorily required by law.  

For selecting medical billing as a career there are certain exams one needs to pass like CMRS, RHIA, and CPB exam. In the USA, a certain university also offers certification courses. These certification courses boost one’s theory knowledge for entering in medical billing company as a good career.                     

Also, this college provides a bachelor’s degree in medical science and technology. For several decades medical billing was done on paper but now with the introduction of software named as medical practice management software the task has become so easy to be managed.                              

Many software companies offer special service. Many companies offer a full portal solution through their web interface. Special training are needed due to changing requirements of US health insurance companies

  • Health is an important key factor related to one’s wellbeing. There is nothing more important than health.  It is often asked, can Health be insured? The answer is yes. The solution   for this question is medical billing company. 
  • There are a certain renowned billing companies in the world. The list includes Anayra Infotech, R.A.R.E. Sol, Piovatal MD, SkyWeb Service, mentalist Outsourcing Services Pvt Ltd, Hir Infotech Data Mining Solution, Ecare India Pvt Ltd, Medical Billing Wholesalers and so on.
  • The medical billing process involves third-party payers which can be either patient or insurance company.  Claims considered as a billing rendered service for patients. This entire process can be called as billing revenue cycle management. It involves managing bills, claims. It takes a month to a year. A relation like a healthcare provider and the insurance company is like a contractor to the subcontractor. The insurance company gives a contract to the health care providers.
  • Though the process is very hectic it is possible due to the Medical Billing Company. Diagnosis and procedure codes are assigned to assist the insurance company in determining coverage and medical necessity of the services. Indirectly we can say that they help the company for getting claims easily. This can be done electronically. When we have to process for claims, few claims are provided to payers in paper forms. In which claims are either manually entered or   with the help of automated recognition software. The software makes the task easy.
  • Here, the payer is an insurance company. To process the claims it hires medical examiners or medical claims adjusters.  For a higher amount company has medical directors to review the claims and checks their validity for payments using a procedure.

Approved claims are taken for a certain percentage of billed services. Actually these bills are negotiated between health care providers and the insurance company. Claims may be failed too. These failed claims are sent to the provider in the form of an explanation of benefit or electronics remittance advice.

Certain techniques are used for patient medical benefit coverage for service rendered. There are mainly two types of claims as rejected and denied. If the claims are denied then provider rectifies or corrects it. The exchange of claim and denials may get repeated multiple times until claim shows zero error.

  • There is a large difference between denied and rejected claim. A denied claim can be corrected by rectifying certain things like correct personal details, his health treatment and so on. The insurance companies have to tell the reasons of rejection.
  • A rejected claims are the claims which have not been processed by the insurer due to a minor error in the information provided. Reasons for refusal include inaccurate personal information or errors in the information provided. Rejected claims cannot be reappeared due to processing problems. They need to be researched, corrected, and studied for the future.
  • Claims clearance has become easy due to the use of electronic way. The care provider makes use of software to check the eligibility criteria of the patient intended service given by the insurance company. Most practice management software use automation method which hides process from the user.
  • In case of medical billing claim the health care provider or medical biller should know detailed schemes of the insurance company, terms and conditions of the medical company plus laws presiding over them. Different company has different plans.
  • The agreement includes all details including fee structures which tells what will insurance company pay the provider for procedures and rules.  The provider takes more from the physician and the insurance company so that he can reduce the expected payment from the insurance company.

The paid amount allowed by the insurer is called the allowable amount. After payment has been done, a provider will receive an explanation of benefits or Electronic Remittance advice along with the payment from the insurance company. Sometimes the task becomes complex too.

So to reduce the problem faced by the doctor, it is largely recommended that one must use a Medical Billing Company. There are many problems in the world but it is up to us how we deal with it and solve the problem.  The best solution is to hire a billing company and to follow its guidelines.

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