In-House Medical Billing

By: Sara Peterson1

Both options have different advantages and benefits. Doctors should weigh the difference between the two carefully when assessing the needs of their practice and what makes the most sense for their accounts receivable situation.

The procedure for processing insurance claims in-house involves several steps that are universal to every practice. First, the office staff will enter information from the “super bill” that was gathered during the patient’s visit into the computer. The employees will enter the information into the medical billing software program. Some of the information they will enter includes the diagnosis and treatment codes and other patient information. The insurance company will use this information to determine the legitimacy of the claim.

Using the medical billing software, the provider than submits the claim to a medical billing clearing house, which verifies the claim and send it to the payer. Before passing it onto the payer, the clearing house will scrub the claim for any errors. The clearing house charges a fee for the scrubbing services. The provider saves time, money and lowers their rejection rates by not submitting the claims directly to the payer. The clearing house has several capabilities which include submitting claims data in various insurance company formats.

Once the payer receives the claim they will either accept or reject the claim. The clearinghouse will receive notification of the claim’s status which than updates the provider. If the claim is rejected, the provider’s staff will resubmit the claim once additional information has been gathered. The medical provider is charged for each claim submission, whether it’s a new claim or a correction.

Ultimately the effectiveness and success of the in-house medical billing process is still contingent on the people involved in executing the medical billing process. If the medical provider plans to manage their accounts receivable in-house they should hire a staff that is experienced, motivated, team oriented and reliable. They must rely on their human resources and their management skills to train and retain a qualified staff.

With an in-house medical billing department, the doctor’s office can full control of their accounts receivable. However, there are several steps involved in processing a claim. Medical providers that employ a highly trained, experienced staff who effectively and efficiently process claims will see many benefits to in-house medical billing.

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