What is Electronic Billing and How Does it Work?

First, the claims processing or billing service acquire the needed information from the medical practice or physician. This data is then entered into the software used. Once the claims have been entered, the operator (biller) then transmits these claims. Transmission is accomplished with the use of a computer modem, communications software and a telephone line. Your claims can be sent two different ways:

1. Directly to the insurance carrier, state or federal programs, OR

2. Routed through a clearinghouse.

With the letter being used, the clearing house will re-edit the claims information sent with a set of more detailed edits, then takes the format you choose NSF propor to claims submission and submits these claims onto the carriers. With a clearinghouse, you will only need the software. It is possible that with direct submission to each insurance carrier, they will require you to buy their software or use their propretary program format (there are hundreds out there). The carrier then makes the final decision on teh claims payment and the physicain receives that payment withing 14-18 days.

What are the Necessary Tools for a Medical Biller?

The services rendered by a Medical Claims Biller are dependant in a large way on several tools. These tools are a vital part to guide you through a successfully billed medical claim. No one expects you to memorize the complete ICD-9 medical, emegency or routine codes or the complete CPT and HCPCS procedure codes or guidelines. With the software you will provide cleanly billed cliams to the carriers, with the necessary data on each claim, insuring few if any denials. A denial can cost long delays in actual payments or in some cases, a permanent denial, where the carrier will not allow a miss-coded claim to be corrected and resubmitted.

In billing a providers claim, 'time is of the essence'. Knowing of, and using the proper tools, are going to be your essential points when offering a provider your service.

Fees for your services may range from:

1. Per claim - between $3 to $7

2. A flat-fee with a cap taking into consideration all your expenses OR

3. A percentage rate of all claims billed, submitted and collected.

4. All other services can be charged per-hourly rate, monthly flat-free rate, or collections can be a percentage of dollar amounts collected.