How Insurance Agents Work with Medical Billers

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April 11, 2017 | Aptus Associates

If you’re interested in the concept of outsourcing your medical billing to professionals so you can focus on other daily tasks, you may be wondering exactly how insurance agents fit into the whole process. Although it’s a complicated process, we can review the general steps of the medical billing procedure leading up to the transmission of an insurance claim to an agent:

Step 1: The medical billing insurance claims process starts when a healthcare provider, like yourself, treats a patient and begins a bill of services provided to the health insurance company. This often involves a lot of medical codes and industry jargon, which can be confusing.

Step 2: There are a number of technical protocols and industry standards that must be met for insurance claims to be delivered expediently and accurately between medical practice and insurance agent. This is why many companies chose to outsource this step of the process. Medical billing specialists typically use software to record patient data, prepare claims, and submit them to the appropriately, which is not always accessible or affordable to rural health clinic workers.

Step 3:  The claim must be submitted. There are two different methods used to deliver insurance claims from the medical biller to the insurance company: manually (on paper) and electronically. The majority of insurance agents prefer electronic claim systems. They are faster, more accurate, and are much cheaper for both sides. Paper claims have not yet been completely removed from the insurance claims process, but fewer and fewer insurance companies want to deal with these. Not all medical offices are yet equipped to submit them electronically, another reason a billing company may be used instead.

Step 4: The insurance agent reviews the information. They then evaluate the claim based on a number of factors in order to determine which, if any, services it will reimburse. If the electronic forms are done correctly, many if not all of the services performed by your medical office should be covered.

Aptus offers a complete billing and accounts receivable management package to primary care and specialty practices, rural health clinics, professional radiology practices, palliative care offices, and hospitals (pro fee billing). We provide a wide variety of options and features for you to benefit from, including electronic billing, speciality specific CPT coding, monthly patient statements, and much more. Reach out to us today to find out how we can help your medical office and work with insurance agents for you.