Claim preparation | Insurance Claims | Medical Billing Services


Claim Preparation

Simplexmed can assist you in the compilation, calculation, submission and settlement of your insurance claim with insurance companies and medical payers.
Not only does our assistance optimize your entitlement, but it also reduces the time claims normally demand; allowing you to focus on what you do best, running your practice and maintaining relationships with patients.
Healthcare providers prepare insurance claims using information provided in the patient’s bill. Occasionally, the claim is prepared manually and sent by mail. In most cases, the claim is sent electronically (having either been prepared using claim software or scanned from a hard copy) to a clearinghouse. The clearinghouse checks the claim for errors, formats it according to HIPAA and insurance guidelines, then transmits it to the appropriate payer, while also sending a report back to the healthcare provider.
After the claim has been evaluated, the insurer must provide both the patient and healthcare provider with an Explanation of Benefits (EOB). The EOB breaks down the adjudication process, showing the dates of service, procedures and charges, patient financial responsibility, and the amount paid to the healthcare provider. At this point, the health insurer sends payment to the healthcare provider, usually in the form of an electronic fund transfer.

Comments

Post a Comment

Popular posts from this blog

Revenue Cycle Startup Thinks It Can Collect On Previously Uncollectable Claims

Image
Claims management  tends to be a reasonably easy method that comes right down to correct execution. However once it does not work things go extremely wrong. Complicated claims are thus thorny, in fact that some hospitals even quit on them entirely. Others suspend on longer than they must. Either manner ends up in lost revenue. What’s additional, the matter is obtaining worse. A median hospital loses some $3.5 million in uncollectable claims, per the informative Board’s most up-to-date  Revenue Cycle  Survey, and suppliers wrote off ninety p.cadditional claims in 2017 than they did in 2011. Hospital says web-bots helped boost location collections by nearly $4 million. These vexing claims are dubbed the “specialized revenue cycle,” and determining the way to collect on them — and once to abandoning — could be a Manus step to optimizing your rev cycle. “Each one could be a snowflake,” same martyr Abatjoglou, corporate executive of Kemberton, a specialized revenue recover
Read more

How Hospitals Compete With Bundled Of Payments At Surprise Invoice

Image
Industry leaders recently proposed implementing bundled payments in the emergency room to solve surprise  medical billing , but the AHA, AMA, and FAH conflicting the suggestion. Surprise medical billing and bundled payments April 09, 2019 – Payers, providers, and other healthcare stakeholders agree that the industry needs a solution for surprise medical bills. But major hospital associations are saying that proposals to implement bundled payments in the emergency department are not appropriate for  patient services . The American Hospital Association (AHA), American Medical Association (AMA), and Federation of American Hospitals (FAH) recently opposed the idea floated during a April 2 House hearing on surprise medical billing. “This concept may seem simple and straightforward in theory; in reality however, this approach would be administratively complex, fundamentally change the relationship between hospitals and their physician partners, and alone, does nothing to pro
Read more

Elec/Paper Claim Submission | medical billing Claim Submission

Image
Elec/Paper Claim Submission According to a recent study by America’s Health Insurance Plans (AHIP) indicating electronic submission of 75% (three quarters) of health insurance claims. This helps practices and providers to process health insurance claims to process within a month of receipt. This not only speeds up the claim submission process, but hastens the AR cycle to the convenience of healthcare provider. In fact, it’s now a requirement by government payers like Medicare and Medicaid to file health insurance claims electronically. In today’s age of getting insurance claims paid the use of automated technology is very crucial. Tools like electronic medical records (EMR) , electronic funds transfer (EFT) electronic remittance advice (ERA), real-time adjudication, claim scrubbing services, coding software products and other technology tools are becoming increasingly necessary. But neither all practices or physicians have enough finances to invest in these costly technolo
Read more