Custom Data Services, Inc. Medical Billing Services:

On our medical management and physician services pages you will notice that the first items that we list as included services are billing services.

What are billing services?

Many organizations operate under the belief that the successful reimbursement of a medical claim is what defines a billing service, but we believe that it takes more.

The successful reimbursement of a medical claim is a part of a progression we like to call the medical billing claim life cycle. Although reimbursement is a critical process in the life cycle of a claim it is not the only critical element.

In order for your practice to gain the most from a medical billing service all stages of the claim life cycle need to be met.

What is the medical billing claim life cycle?

Data Collection -> Processing -> Adjudication -> Reimbursement

Data Collection
The first phase, and in my opinion the most critical phase, of the MCLC is data collection. Data collection is performed before, during, and after the medical service has been completed. The accuracy of the collection of patient insurance information, registration information, procedural data, and physicians orders directly corresponds with a reduction in filing errors and a reduction in accounts receivable turn around time.

Processing
The processing phase involves everything after the patient has left your office. During the processing phase we perform the data entry, apply CPT procedural codes, collect additional data that may be necessary, and submit the claim for adjudication.

Adjudication
The adjudication phase begins with the electronic submission of the medical claim to the responsible party; the primary or secondary insurance, or patient. Once the claim has been submitted it will either return a result of accepted or denied. If a claim has been accepted we will begin the reimbursement phase. If a claim has been rejected we must return to the data collection phase to correct or retrieve data that was collected inaccurately. Will will refile the claim or make an appeal on the adjudication.

Reimbursement
The reimbursement phase involves receiving and dispersing payments to the correct patient accounts, storing claim explanation of benefits, and balancing accounts receivable journals. If an account has a open balance the processing phase will began on the account to recoup the remaining debt owed to you.

Conclusion Although the result of a successful revolution in the MCLC is complete reimbursement of a medical claim, it is necessary to understand that every phase of the MCLC is as important as the phase before it. Understanding the life cycle will reduce errors, reduce cost, and increase collections.

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