The term “medical billing” refers to the process of filing medical claims with health insurance companies so that physicians or other healthcare providers can receive payment for services rendered. In addition, medical billing involves conducting a follow-up on medical billing claims to determine the status of insurance company approval and the status of payment.
Over the years, medical billing has shifted from paper records to electronic records. This innovation has reduced the cost of processing medical claims and also improved customer care by storing medical histories, physician referrals and treatment plans in a central location that can be accessed across a network. This type of fully integrated electronic solution is commonly referred to as Electronic Medical Record or EMR.
Healthcare providers are increasingly considering the benefits of outsourcing many of their medical billing, claims processing and medical coding processes. These services are outsourced to less expensive labor such as in India and parts of Europe. Also, many medical billing workers work from home. Employers who outsource their medical billing work benefit in a number of ways. Medical billing and claims processing can require a large staff to perform data entry and advanced medical billing tasks. By outsourcing, these healthcare providers do not have to pay for office space to accommodate this large workforce.
An electronic medical record, or EMR, is a computerized medical record. An EMR allows patient data to be accessed by medical personnel anywhere within a computer network. It also means that clinical staff can enter patient data that everyone else on the data network can instantly access. These fully integrated types of data management systems allow healthcare providers to easily plan treatments and care plans that do not conflict with data entered by other members of a healthcare provider patient team. This also reduces the risk of medical errors that occur when paper records are not updated, or even when sloppy handwriting makes it difficult to follow doctor’s orders.
Before electronic doctor billing systems, doctor billing and service processing was almost exclusively on paper. With the advent of computers, it has become possible to efficiently manage large claims using electronic medical billing software. Many medical billing software companies offer medical billing software to this particularly lucrative segment of the market.
The medical billing space has been challenged in recent years by the introduction of the Health Insurance Portability and Accountability Act. Due to numerous restrictions introduced as a result of these new laws, many medical billing software companies and health departments have spent thousands, in some cases tens of thousands of dollars on updated technology. Those affected by HIPAA have had to redesign and restructure their business processes and software to be compliant with this new law.
So-called “Straight Through Billing” has also developed over time. Direct billing integrates the billing process into the practice management workflow, connecting patient planning, healthcare delivery and medical records management. Every member of a practice’s management workflow receives an updated, unified, and coherent picture of the practice’s workload, patient and provider location, resource availability, and cash flow. Straight-through billing requires integrated electronic medical record and straight-through billing technologies.
As the medical billing industry evolves, these innovations help healthcare providers by lowering their operational costs, but more importantly, patients receive better, more timely, and accurate care, improving the satisfaction and well-being of many patients.