The World of Medical Billing
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Management for Organizations 330
September 2, 2007
The World of Medical Billing
Everyone has been to the doctor or hospital and incurred medical bills. Some hospitals and doctors do their own billing while others outsource the billing. When the billing goes smoothly, patients never know how the billing took place. I work for a medical billing agent. I have seen many changes in the three years I have worked there. More changes are on the horizon. The industry changes include: moving to an electronic environment, complying with changing HIPAA regulations, and changing technology.
When I started with the company, half of our claims were coming through the mail from the hospital, and the other half were coming in an electronic file that needed to be printed and collated. Now all of the reports come through electronic files. The reports are moved from the file to the system and the only time they are printed is when they need to be sent back to the hospital for corrections. Another important aspect that has changed is the submission of the claims to the insurance companies. The company now submits the claims through electronic files. We send between 8,000 and 10,000 reports a day, and of those only 100-200 are printed on paper. The claims printed on paper are for insurance companies that we either get too few claims to submit electronically or they do not accept electronic claims. The claims that we submit electronically, we also received the payment files back electronically. They still send us a paper explanation of benefits to show how the claims should be posted. ...