Medical billing is a critical function of the financial cycle for all health-care providers. Whether the medical biller is part of a single provider service or a large hospital, their job is crucial. After all, they are a direct connection between providers, patients, and the insurance companies. Medical billing requires accurate analysis, detailed coding, and proper data analytics in order to achieve company success and offer its clients the value it deserves.
Essential Functions of Medical Billers
Healthcare costs and insurance plans are complicated at best. They not only offer widely differing plans for their patients, but they each have their own rules that medical billers have to know. On top of keeping track of this complicated system, medical billers are also responsible for the following functions:
- Obtaining referrals and pre-authorization for medical procedures.
- Verifying eligibility and benefits verification for hospitalizations, procedures, and treatments.
- Verifying that information is complete and accurate before billing the patients.
- Following-up on medical claims.
- Payment disbursement.
- Re-negotiating underpaid claims.
HOW TO USE DATA TO DELIVER MORE VALUE
Medical billing comes with a lot of scrutiny and can be a complicated and frustrating process for many patients and caregivers. However, by using the right data and technology, this process can be enhanced for both providers and patients. Helios offers outsourced Chief Data Officer services that can help medical billers utilize their data by performing a predictive analysis of their data. This process will help their company produce accurate results while simplifying the complicated billing process that can be a headache for most medical billers. With Helios, medical billers will have to opportunity to optimize the following:
VERIFICATION OF BENEFITS
Verification of benefits is essential to gaining information regarding patients’ insurance coverage. Confirming this information helps reduce any surprises and can also assist with appeals. Data analytics will help their customers use predictive modeling to show a client what they should expect to get paid from their insurance carrier and how long it will take to receive that payment. This process substantially reduces incorrect or conflicting information and also speeds up the process as a whole.
UTILIZATION REVIEWS
The utilization review is a process where the appropriateness of a health care service is evaluated against its medical need and relevance. This review benefits both the patient and the provider by providing a streamlined health care process and eliminating unnecessary procedures. With Helios, customers are able to compare patient billings and review what claims were approved for similar circumstances. This key technology will assist the UR reps by allowing them to present their cases effectively to the insurance carrier to get approvals for additional care.
TRACKING CLAIMS
Tracking medical claims and making sure they are timely ensures that a healthcare provider is reimbursed and that a patient is not left with lingering medical payments. With the right analytics, customers will be able to track all their outstanding claims and create alerts when follow-up is needed.
PAYMENT TRACKING
It is critical for medical billers to pay attention to payment summaries and that insurance payments have been posted. Not tracking this information can result in a company’s revenue suffering. The right data not only helps customers track their payment statuses, but also allows their clients to receive real-time visibility on their expected payments.
In the world of medical billing, it is crucial that information stays private and protected while also staying as accurate as possible. Our skilled and dedicated team of data analytics experts will make sure your system runs faster, is more reliable, and that your overall company goals are achieved. Contact us today for more information.
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