Introduction 

It’s no secret that the healthcare business is flourishing, and this trend is anticipated to continue. With a population of more than 46 million Americans aged 65 and older, which is expected to treble by 2060, and 68 percent of them suffering from two chronic conditions, the demand for healthcare personnel is not going away anytime soon.

Technology has played an important role in the advancement of the healthcare business. Traditionally, diagnosing and treating patients was a time-consuming and resource-intensive process. Rapid technological growth has enabled the creation of high-tech medical equipment, cost-effective drugs, and novel processes that have simplified every medical function and increased the quality of healthcare services.

What is Medical Billing?

Medical billing is an essential element in the smooth operation of any hospital or medical practice. Preparing billing claims and submitting them to insurance carriers is what medical billing entails. This guarantees that the hospital or medical office receives the right reimbursement for the services provided to patients.

The process of creating valid patient claims or bills based on coding and forwarding them to insurance companies for payment is known as Medical Billing. Based on the codes, insurance companies will approve or refuse payments. Any payment for medical services that are not covered by the insurance policy will be given to the patient. When a patient schedules an appointment with a medical practice, the billing process begins.

Medical offices are funded by commercial insurance companies as well as government-funded healthcare programs such as Medicare and Medicaid. Receiving adequate funding permits the medical office to remain operational. With little remuneration, it is difficult for them to give excellent care to patients.

The Current State of the Healthcare Industry

To meet the needs of patients while remaining competitive, the healthcare system must adapt and evolve at the speed of technology. In recent years, the healthcare sector has faced various issues, including:

• Healthcare prices are rising.
• Inadequate patient-specific therapy.
• Processes that are inefficient.
• A growing number of people are suffering from both acute and chronic illnesses.

With the Coronavirus pandemic, the healthcare system’s capacity and capability are being put to the test, and many health centers are overcrowded and understaffed to deal with the rising number of patients. The shifting changes in the medical area have an immediate impact on both patients and healthcare providers. From the perspective of a patient, healthcare focuses on the:

• Insurance coverage indicates whether the patient can afford the costs of treating acute or chronic sickness.
• The proximity of healthcare facilities and services.
• Disease diagnosis, treatment, and prevention in a timely manner.

Adopting and implementing technical solutions, such as current equipment and digital transformation with novel software and systems, is the solution to practically all the healthcare industry’s difficulties.

Impact of Medical Billing on patient healthcare?

When a person becomes ill, going to the doctor may appear to be a single encounter between a patient and a doctor, but it is part of a larger network of information, medical services, and payments. The entire medical diagnostic and treatment procedure is a three-step process that comprises:

• The insurance company or payer.
• Patient 
• Healthcare Provider (includes hospitals, clinics, physicians, emergency rooms, physical therapists, and outpatient facilities).

The medical biller’s function is to negotiate and arrange adequate payment between the three parties. The biller makes certain that healthcare practitioners are properly reimbursed for their services. The biller gathers information on the patient and medical treatment from the super bill, and then compiles that information into a bill for the insurance company, known as a ‘claim.’ The claim includes the patient’s information.

• Medical background
• Information on demographics
• What medical operations (procedure codes) or services were performed, and why? (diagnosis codes)

There are several forms of health insurance, with certain operations and services covered and others not. The medical biller’s role is to analyze the patient’s insurance plan or coverage and then utilize that information to produce an appropriate claim. A medical biller submits a claim using both procedure and diagnostic codes provided by medical coders.

• Procedure codes are CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes that indicate what service was delivered to the ‘payer.’
• Diagnosis codes are ICD (International Classification of Diseases) identifiers that indicate the medical necessity of a condition.

In addition, the medical biller checks that the claim is compliant, which implies that the information is correct. If the claim is granted, it is returned to the biller with the amount paid by the payer. The biller then collects the remaining balance and returns it to the patient.

Purpose of Medical Billing

Until the 2000s, the majority of medical coding and billing was done manually, which entailed a massive quantity of paperwork for coding and subsequently invoicing the claim. If the insurance company declined payment due to coding or billing errors, the paperwork grew.

Medical billing is a meticulous task that takes valuable time, and in times of global pandemic, it can be difficult for medical practices to train and recruit professionals who can handle both the coding and billing tasks efficiently, and claims that are not processed correctly can have a direct impact on the revenue cycle.

The hospital billing software systems are completely reinventing the claim processing and payment collection procedure. The biggest advantage is that it streamlines the procedure and reduces mistakes, allowing medical professionals to focus on providing better care to patients.

Electronic Health Records (EHR) have also shown to be quite useful in the healthcare business, particularly for medical practitioners. In comparison to papers, EHR helps to keep a clear and full patient record.

Conclusion

Health insurance is an important form of insurance plan that covers or pays for the insured person’s medical or surgical expenditures, prescription medicines, and some dental charges. People who have health insurance are referred to as “insured or subscribers,” and they pay a certain amount of money to cover medical bills.

Oriental Solutions is a certified firm that provides comprehensive, user-friendly medical billing and coding solutions to a variety of healthcare institutions. Hospital systems, healthcare consulting organizations, and physician clinics are among Oriental Solution’s clientele.