If you own or run a medical facility, providing healthcare is your core business. However, getting paid for those services is critical to staying in business. For this reason, you should understand the claims process to ensure continued cash flow. Medical claims are the bills you provide to patients’ insurance caries so that you get reimbursed for your services. 

5 Steps to a Medical Claim

The medical claims process has five essential steps, and the journey begins when patients check in at your healthcare facility. Here’s an overview of the steps:

Step 1: Patient Registration

Registration occurs when patients check in at your medical facility and provide their personal details and insurance information. You should ensure that your team records this information accurately.

Step 2: Insurance Eligibility Verification

At this stage, you verify whether the patient has adequate coverage for the healthcare service they need. 

Step 3: Medical Coding

This occurs after treatment and entails transcribing the medical notes and critical clinical documentation into medical codes. These codes describe the diagnosis made, as well as the procedures and prescriptions administered to the patient. 

Step 4: Charge Entry

Here, you list the charges you expect to receive from the insurer after submitting your claim for payment. 

Step 5: Adjudication

When the insurer receives your claim, they’ll evaluate its validity and decide the amount they’ll reimburse you. 

What are The Elements of a Medical Claim?

As a healthcare provider, it’s essential to understand your obligations under insurance agreements when filing medical claims. For you to get reimbursed for the healthcare services offered, you should prove that: 

• Healthcare services were provided. 

• Your facility and services meet all insurance coverage rules. 

• The medical claim is accurately coded and describes a patient’s condition and the diagnosis, prescriptions, supplies, and procedures administered. 

• The healthcare services offered to the patient were medically necessary. 

• There were no statutory violations when administering healthcare and filing the claim. 

How Can MyeMed Help Outsource Your Billing and Claims?

When offering healthcare services, your facility’s financial health is equally critical. However, keeping up with the paperwork needed to file medical claims and navigating the dynamic tides of the medical insurance industry can take time, thus the reason to consider an outsourced billing partner. At MyeMed, we pride ourselves on being a dependable outsourced medical billing partner you can trust to meet your revenue targets. 

We are committed to helping you focus on your core business, which is to provide quality healthcare, while we manage your revenue cycle expertly. Our team understands the critical role medical billing plays in your facility’s revenue cycle. Thus, we leverage our over 30 years of experience to ensure faster and more efficient collection turnarounds. If you want to lessen your facility’s administrative burden and financial losses related to medical claims, fill out our contact form to learn more.