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How Does the Process of Submitting Medical Billing Claims Work?

Aug 17, 2007
Understanding exactly what happens when the claim is sent from your office to the time you are re-reimbursed for your claims, will help make your decision to outsource your medical billing a lot easier. No matter how you get your paperwork to the billing company, the claims submission process is roughly the same for all claims. This standardization in submitting claims, make the reimbursement process a lot faster for you.

You are well acquainted with the procedures for coding and documenting a patient's visit to your office. If you do your own billing inhouse, the claims are then sent by your office staff to the carrier or Medicare for reimbursement. The reimbursement process can take anywhere from 3 to 6 weeks if you are filing your own medical claims.

When you let an outside service handle your medical billing claims, you'll find your reimbursements will happen within a couple of weeks. The process is very simple and also very secure to ensure the highest in patient confidentiality.

First, you transmit your claims for coding to the company you are outsourcing your claims to. At the medical billing firm, your paper claims are entered and double checked for errors and then transmitted in batch orders. If you file electronically from you office the billing company simply downloads your claims via secure server.

Medical billing claims are transmitted via secure, encrypted data transmission. Transmissions are either sent directly to the carrier or to a clearinghouse. Clearinghouses edit the information into a standard format and then send it on the carrier to be processed.

Using a clearinghouse is a good step in catching the occasional medical coding error that might slip by. This method of checks and balances will further help your revenue flow as you will experience fewer than 1% of your claims being delayed due to errors in coding. Then, the carrier receives the claim and usually transmits a confirmation of receipt so the claim can be tracked. Normally reimbursement takes place in about 2 weeks using electronic claim filing.
You should receive a reimbursement check along with an Explanation of Benefits (EOB).

From the ease of having your medical billing claims submitted for you to being able to get a status on any claim with just a phone call or a click of a mouse,to the speed of getting your claims reimbursed, you can't go wrong outsourcing your claims.
About the Author
Kurt Clark is a freelance writer & CEO of Kurt Clark, Inc, a web development firm. Learn more at: http://www.kurtclarkinc.com

Based on interview with the Director of Billing at OMG, http://www.outsourcemanagementgroup.com
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