Medical Claim Billing

The process of medical claim billing involves first converting medical data into standard medical codes which are then submitted as a bill consisting of those codes to the relevant insurance companies who then pay the claim using pre-agreed payments for particular combinations of codes.

The job of medical billing is considered a sub-area of medical coding as the information in the medical bills is sent in the form of these standard medical codes. These professions are great career choices right now due to the rising percentage of elderly people in the populations of western world countries. The number of jobs in these areas is rising significantly faster than the average.

The interaction between the medical billing of claims and the insurance company paying for those claims is not always straightforward or simple. There are often disagreements about how much can be claimed for and other sources of error in the process. Some insurance companies still process claims using a paper-based system instead of doing things electronically, which leads to additional errors as well as considerable delays.

One method of helping get claims processed quickly and effectively is to submit the bills via a clearing house instead of directly. This reduces the amount of errors and speeds up the process.

There is now a company given the task of finding errors in medical claims. Large numbers of errors are found, mostly concerning over payment. The fact that the company involved gets paid according to the amount of money it recovers by correcting errors is controversial for obvious reasons.

Most medical claims are currently submitted electronically, mostly using specialist software. Ability to use this software is one of the areas medical billing employees are trained in.

Medical claim billing is a vital part of any healthcare business, and a good career choice currently.

Medical Classification is Medical Coding

What is medical classification and what is medical coding? Well, both the terms refer to the process of transforming details of medical diagnostic processes and diagnosis into medical code numbers that are universal. The four basic categories of coding are diagnostic codes, procedural codes, pharmaceutical codes, and topographical codes. The diagnostic codes are used to group and identify diseases, disorders, symptoms, and medical signs, and the procedure codes are numbers or alphanumeric codes used to identify specific health interventions that are taken by medical professionals. While the pharmaceutical codes are about medications the topographical codes indicate the concerned body part.

From where are all these details about the patient's disease and his medical history taken? Some of the sources include,

Doctor's notes Biochemistry Lab reports Radiology reports

What is the use of these medical codes? They are used to track diseases and quite useful for health insurance companies, government hospitals, worker's compensation carriers etc. These medical coding/ classification system applications are mainly used for reimbursements of the medical bills from insurance companies. It is also used for statistical analysis, in epidemic surveillance and for knowledge based decision support.

Here are the different types of medical classifications;

Reference Classifications International Statistical Classification of Diseases and Related Health International Classification of Functioning, Disability, and Health International Classification of Health Interventions International Classification of Primary Care International Classification of External Causes of Injury Anatomical Therapeutic Chemical Classification System Technical aids for persons with disabilities: Classification and terminology International Classification of Diseases for Oncology, Third Edition ICD-10 for Mental and Behavioral Disorder Application of the International Classification of Diseases to Dentistry and Stomatology Application of the International Classification of Diseases to Neurology International Classification of Functioning, Disability and Health for Children and Youth Procedure Coding System Diagnostic and Statistical Manual of Mental Disorders Systematized Nomenclature of Medicine TNM Classification of Malignant Tumours Unified Medical Language System Mendelian inheritance in Man Current Procedural Terminology Health Care Procedure Coding System North American Nursing Diagnosis Associates Logical Observation Identifiers Names and Codes International Classification of Headache Disorders 2nd Edition This article has been viewed

Medical Billing And The PPO Plan

Medical billing is the process of collecting fees for medical services. A medical bill is also called as a claim that has to be collected from the insurance company. There are different types of insurance plans. What is the PPO plan? PPO is a term used in health insurance that stands for Preferred Provider Organizations. It is a managed care organization of medical doctors, hospitals, and other health care providers who are associated with an insurer agent/administrator's clients to provide health care at reduced rates. It is today one of the most preferred kind of health care plan in the country. A preferred provider organization is sometimes also referred to as a participating provider organization.

More than 50% of the insured population in the US have chosen to go for the PPO plan. Its popularity is mainly because of the fact that in this system, doctors / hospitals have made an agreement with the insurance companies to offer discounted fees to the company's members.

The primary advantages of going for the PPO insurance plan are,

Its not mandatory to maintain a primary care physician

Can directly see a specialist without referral

Freedom to choose own doctor / hospital

The main advantage of going for a PPO plan is that one can choose a health service provider from outside the provider list Another less popular system is called an (EPO) exclusive provider organization (EPO), wherein if you seek care from a non-preferred provider there is no coverage at all. One must remember that with freedom to choose will always mean more expensive medical bills.

There are many types of PPO plans and the actual benefits depend on different factors like,

Monthly premium amount

The amount of coinsurance obliged to pay,

Whether treatment from the network/ outside

Annual deductible amount

What are the other features of a preferred provider organization? They generally include services of review of the patient records by the company representatives to ensure that there is no foul play. In the case of non-emergency admissions, an approval is taken from the insurer in advance.

View the original article here

The Definition of Medical Malpractice

Medical malpractice has become a greater concern for doctors over the years. The age of lawsuits means that people are quick to sue for any wrongs they feel have been committed against them. While most doctors do everything they can to avoid being sued for malpractice, sometimes there is just nothing they can do. Even when they do everything right, something can still go wrong - and the doctor often takes the blame for these problems, whether they were responsible or not. Unfortunately, it is very simple for someone to bring a lawsuit against another person today, but on the bright side there is a complex process which rules out most frivolous suits.

The definition of medical malpractice is the deviation by a medical professional from the standards of the medical industry, thus causing injury or death to a patient. True medical malpractice is rare, but lawsuits for medical malpractice are not very rare. Successful malpractice suits must follow the definition of medical malpractice in that they prove that the doctor, through action or inaction, caused wrongful injury to a patient. Typically, this means that a practitioner grossly violated the standards set by the medical industry.

Because of the presence of medical malpractice lawsuits, medical professionals are required to maintain personal liability insurance to protect them and offset the costs of malpractice suits. However, in keeping with the definition of medical malpractice, the lawsuit must prove that the medical professional violated medical standards. This requires an expert to prove that there was a violation of standards. With medicine becoming more and more advanced, there are more things that can go wrong. This means that malpractice suits can take advantage of the legal aspects of medicine not being caught up with the practice.

As new medical practices continue to push the envelope, people will seek reasons to sue when things go wrong, but the definition of medical malpractice protects doctors from many lawsuits filed by people who are just looking to put the blame somewhere. Fortunately for doctors who are concerned about wrongful lawsuits, there has been a recent push to reform many of the torts which govern the medical industry. They are intended to eliminate lawsuits filed by people who, for whatever reason, feel they were wronged by their doctors.

There have been numerous high profile lawsuits against doctors who were said to have violated the definition of medical malpractice, but the fact is that these expensive lawsuits negatively impact the ability of the medical industry to offer quality care when they are brought about by people who are simply seeking money. With the new reforms that are being put into place, it is likely that frivolous lawsuits will begin to decline. As it is, they are on the rise and have been for quite some time. If something is not done to stop wrongful medical malpractice suits, the medical industry will continue to be inhibited in its ability to provide quality care at reasonable cost.