South Florida Medical Billing Software

One of the most vital aspects of the medical industry, aside from the actual medical services, is the medical billing. The Medical Billing procedure is the interaction between a doctor’s office (billing staff) and the insurance company. The process starts when a patient is seen by the doctor. The doctor’s office books the appointment, creates a file (or update an existing file) with the patient’s current medical record. During the appointment, the doctor’s office will give the patient one or more diagnosis and treatments. The patient’s record is updated with this diagnosis and suggested treatment. Once the file is updated, the diagnosis is then translated into a special 5 digit code. (Created from the Current Procedural Terminology)

Once the final diagnosis and suggested treatments have been documented, the medical biller can now do their part of the job. This person transmits the claim to the payer’s insurance company. Generally, this is done electronically through a special medical billing software

. In the past, most medical claims were submitted in a paper form; in the case of professional (non-hospital) services and for most payers the CMS-1500 form or HICF (Health Insurance Claim Form) was (and is still) frequently used.

The patient’s insurance company processes the claim. This is done by paid medical directors that review the claims and evaluate the validity based on the patients policy and the insurance companies guidelines. Once a claim is approved, the healthcare providers are reimbursed. Failed claims are rejected and notice is sent to provider.

South Florida Medical Billing Software