Medical billing is the process of submitting medical claims of patients to insurance companies on behalf of health care providers. Efficient medical billing insures the success of the practice as it creates predictable cash flow for the health care provider.

Today, many health care providers are outsourcing their medical billing. It’s the fundamental responsibility of the professional medical billing company to monitor the billing cycle where rejections and denials are handled in a timely manner. Moreover, it is key to follow up on any disputed portion of the claims and reduced reimbursements. Let’s find out more how the medical billing cycle works.

The process starts with entering the patient demographics and insurance information into the practice management solution by the medical billing group. It is important that the medical billing team makes sure that the patient is eligible for the service before the patient comes in. Once demographics have been entered, the medical billing team enters the CPT and ICDs codes into the system after making sure that the codes are compliant with government regulations and policies. Since; ICDs and CPT are subjected to annual change and policies are often updated throughout the year. The process of entering CPT and ICDs in the system before submissions is called charge entry.

Charges have to go through certain manual and electronic claim edits. After they have passed the edits, claims that are ready to be submitted are called clean claims. Failed claims are sent back to the biller with notification for correction and re-submission. Cleans claims are then forwarded over to the clearing house in 837X12N format which makes sure that all claims are complaint to current regulations and are following the right EDI standards. An efficient clearing house transmits all approved and rejected claims back to the practice management solution within 24 to 48 hours.

Accepted claims are transmitted to the insurance EDI department which preps the claims and matches the transmitted information with that of the patient file and benefits. After EDI review at the payers end, the approved 837 claim files are forwarded over to the payer adjudication department and rejections come back to the office from payers via the clearing house.

The adjudication department approves payment on the accepted claims at the contracted rate and forwards them over to the finance department which either pays them as an EFT (Electronic Fund Transfer) or by paper check. (EOB) (Explanation of Benefits). Physician offices receive EOBs on the credentialing billing address and then they are posted into the system by the medical billing team to show an accurate picture of the account receivables.

Any rejections from the clearing house and payers along with the EOB and ERA denials are worked by the AR team for payment resolution and re-submission. With an ideal medical billing service all denials should be fixed and resubmitted the very next day when they come in. Also, all outstanding claims should be followed up within 30 days in case of non-payment. Ideally all claims with commercial and government plans pay within 2 to 4 weeks in compliance with state prompt payment regulations that vary from depending upon location.

Do you have any idea why India is preferred as a medical tourist destination by foreign patients? Well the most obvious answer is best health care facilities at low cost. The broken state of health insurance and sky scrapping prices of medical treatments in the western hemisphere has burned a hole in the pocket of people. Despite of the fact that the heath care system of the U.K. and U.S. is quite advanced, the high cost of treatments has stimulated Europeans and Americans to opt for South East Asian countries. Countries such as India, Bangkok and Thailand are quite popular as affordable destinations for medical tourism.

With multinational hospital chains, state of the art infrastructure and affordable long term accommodation, skilled surgeons and compassionate staff, India prove to be bang for the buck for overseas patients. The country has a significant chunk of medical specialists who have studied and practiced abroad before returning back to their home. Indian hospitals are well equipped to perform crucial surgeries for joint replacement, cosmetic correction, organ transplants, urology and In Vitro Fertilization. In this article, I will give a brief overview of the aforementioned treatments offered in India.

Joint Replacement

Joint Replacement is that procedure of orthopedic surgery wherein damaged joint surface is replaced with an orthopedic prosthesis after putting the blood vessels and nerves in place. The artificial or prosthetic joint is made up of a special metal or carbon-coated implant. The surgery can be conducted for replacing joint of finger, knuckle, wrist hip and knee. This surgical treatment has its own set of pros and cons such as reduction of joint pain, improving alignment of joint, improvement in overall hand function, infection, joint stiffness and dislocation of prosthetic joint.

Plastic Surgery

Plastic surgery is that branch of medical treatments which deals with correction of injuries and deformity in a particular body part. Although most people undergo cosmetic surgery for aesthetic look, there are various other categories that include reconstructive surgery, microsurgery, hand surgery and burn treatment. The most common procedure of plastic surgery is skin grafting which refers to the transferring of skin tissues. This procedure is used to treat excessive wounds, burns and infections such as vitiligo. Skin grafts can be produced from both recipient as well as donor. Other procedures of plastic surgery are lip enhancement, liposuction, butt augmentation, Rhinoplasty, hair restoration, Botox fill and pediatrics.

In Vitro Fertilization

Nothing could be more frustrating and draining than the desperation of having a child and inability to have one. With the emergence of advanced medical technologies, today, people around the world have conquered infertility. In Vitro Fertilization is one such procedure. In this procedure, a man’s sperm is introduced to the woman’s egg in a fluid medium in a laboratory for fertilization. Post fertilization, the embryos are placed in a gas incubator to simulate the environment of the uterus. Thereafter, it is planted into the woman’s uterus using a catheter via the cervix.

Urology

Urology is a medical specialty dedicated to diagnosing and treating disorders pertaining to urinary tracts of both males and females and male reproductive system. Urologists are the medical professionals who are extensively trained to identify, treat and look after patients with urological disorders. It covers treatment of urological cancers, male sexual dysfunction and incontinence.

Multi Organ Transplant

Multi Organ Transplant in India has seen a meteoric rise because the surgical procedures are carried out with utmost care and under the scrutiny of expert medical specialists. When it comes to multi-organ transplant, considering a patient of life support system is the best choice. Family members are given more preference because the chances of perfect matching are high. Organ transplant is followed by a long convalescence process wherein a patient is kept on immunosuppressant disease to assist the proper functioning of the transplanted organ.

The aforementioned treatments are among the popular medical arenas for which foreign patients flock to India in large numbers. The expert surgeons, world class infrastructure, caring staff and low cost of treatment make India a worth visiting place for overseas patients.

With advances in surgical procedures and drugs that are more operative at preventing denial and controlling infection, transplantation of an organ are now accepted as the most effective treatment. It is accepted as the most effective procedure for many diseases leading to end state organ failure.

These treatments hold out the hope of life to thousands and let many others to live a better quality of life. If you are getting yourself treated from one of the best heart hospitals in India then you do not need to worry about their excellence for organ transplantation. They cater the needs of their patient’s well- especially them whose vital organs have been severely infected and injured.

Once you give your responsibility to them you do not need to worry much about your health. The medical skills of the surgeons and the overall team with the superb infrastructure available bring the best options, easily accessible for you, so that they can carry out complex method. For instance, Kidney Transplantation in India is carried out easily by the doctors. This procedure is also called renal transplant. Kidney transplant is an operation where a healthy kidney is placed into the body of a patient whose own kidneys have been failed. It is restored for the patients who are in the end stage of renal disease. Depending on the source of the organ donor, kidney transplantation is classified into different types.

These are the three different types of kidney transplantation that is carried out by the surgeons. You do not need to worry if you are suffering from any types of kidney problems. Simply, visit the doctor as early as possible to get treated in time. Their excellence for organ transplantation has a comprehensive kidney transplant program along with strict process in its place. Their clinical expertise, better infrastructural support and high standard follow up care maximize the chances of a successful transplantation process.

The healthcare industry is a large enterprise that involves a number of tasks apart from the treatment of patients. Administration is an important aspect that cannot be neglected; hence initially a numerous hospital staff was made to perform these tasks. As a result of which time and efforts was wasted arranging and manually updating the patients’ personal details and medical history. Thus in order to channelize the efforts into more productive tasks, the hospitals has separated the administrative tasks from the treatment procedures. This separation of the two tasks has led to development of Medical Services Outsourcing. Outsourcing is a method adopted by nations to create alliances on an economical level and increase the foreign revenue on the whole. The establishment of this strategy has helped millions of unemployed people come out of the economical facade and engage in a productive career. Since the job description is not too demanding, people can balance their personal affairs along with having a career. This job requires individuals that have a fair knowledge regarding medical terminologies. Along with a basic background of theoretical medicine, the individual must produce accuracy up to 95 percent at least.

Medical Transcription Companies have flourished over the last few years in order to help the hospitals manage their administration and get that load off their shoulders, so that the staff can deal with more important procedures. Medical records of a patient include their post operation details, medical history, personal details and other relative details like allergies, medicines etc. Hence it is a very important document that gives the consulting surgeon an idea of a patients overall status. The necessity of these records are dire, hence accuracy is a compulsion, not an option. These transcription agencies have to produce prompt services couple with efficient services. These companies utilise the Internet to make any sort of communication with the allied healthcare industry. To manage a healthy relationship, the two parties must provide adequate help and support to each other. Maintaining ties help in development of both the enterprises. The demand of medical transcription has surged on account of the increasing number of hospital admissions. The indirect relevance helps maintain the development of the transcription agencies.

The growth in requirement of Medical Services Outsourcing has surged as developing nations are suffering from unemployment on account of the massive population rise. This platform helps people juggle their personal lives along with pursing a career. The income rate in this sector is considerably good; hence people are more drawn to it as a full time career. Medical transcription companies have managed to develop foreign ties with major developed nations, which have proved useful to the nation’s economy. The pace of development in this field is compensating for population rise to quite an extent and people are benefitting as well. With such massive advantages, this sector has paved a path to regain a far more strong economy in nations like India, China etc. The internet has helped in development of this enterprise to quite an extent on account of its convenience and easy accessibility.

In today’s medical environment, diagnostic X-Ray is a crucial method with the help of which patients can be treated properly. In case of emergencies, doctors always advise patients to have a diagnostic x-Ray done in order to see the actual conditions of the internal organs. Most of the southern radiology clinics are located close to the hospitals so that patients can come up to them for any kind of test and at any time in case of emergency.

Some of the hospitals have their own emergency X-Ray radiology wards where the radiologists perform the tests and generate images of the human body which help doctors to treat patients fast and accurately. Some of the digital imaging techniques provide very quick images with a higher resolution so that the images are clearer. With the help of another diagnostic imaging technique, known as fluoroscopy, doctors can inject patients in the right vein and can also see as to what amount of medicine is being injected. As a result, the percentage of human errors committed is reduced. With the help of fluoroscopy, fractures can viewed perfectly and thus help doctors during operation.

CT Angiogram is a better technique of digital imaging. It does not require X-Ray or any magnetic field. So it can be termed as safe. CT Angiogram uses a contrasting agent which is injected in the patient’s body either orally or by injecting via the rectum. Mostly, patients feel uneasy with the contrasting agents as they have to drink it. But these agents are not harmful. At first, patients may have a vomiting tendency, but later it passes away.

CT Angiogram is performed on different parts of the body. Heart is one of the most vital organs of the human body. Today many people experience blockage in heart and other complications as well. With the help of CT Angiogram, doctors can treat patients accurately and perform operations depending on the complications. Angioplasty can be done if the patient has blockage in the narrow coronary arteries. If the patient has further complications and they are critical, then bypass surgery is a better option.

With the advent of cloud computing, e-labs and e-diagnostics have come up which can help patients take diagnostic x-ray and other tests online, thus reducing the cost. In these tests, light weight and simplified instruments are used so that it becomes easy for radiologists to maintain these equipments. The equipments are portable and can be accessed from anywhere in the world at any time. Some of the southern radiology clinics have these online techniques to make patients more convenient. These techniques are also user friendly. But these online services must be protected with the highest security solutions as hackers might tamper with the records of the patients. Doctors observe the X-Ray Radiology and CT Angiogram reports closely and make changes in them so as to help them treat the patients. In most of the emergency cases, doctors might need to refer to the reports multiple times. So it should be entirely the responsibility of a radiologist to store the data properly and securely.