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Looking at a scenario where a patient walks into a clinic to meet a physician, for a general visit (known as the office visit in the United States of America) there is a procedure that goes along his visit, which is detailed below:
Every individual in the United States of America having a medical insurance has a medical insurance number which would be a part of the patient demographics, (at times a patient intending to meet a physician need to get an authorization from the insurance company and the insurance company in return would authorize the time slot and the reason for the patient to meet the physician.)
When the patient walks into the clinic and has a check up he would be billed to the insurance company, be it his primary or secondary or the tertiary insurance coverage, with the procedure codes and the amount applicable for each procedure code which is prefixed by the insurance company, the remaining is either taken as co-pay or if the patient has a secondary insurance coverage they would take up the remaining charges of the patient.
When the payment comes back from the insurance company it comes as an EOB (Explanation Of Benefits) with details of payments made by the insurance company for the procedure codes, if the payment is denied there are references for the same, that gives the reason why the payment was declined, there could be instances where either of the insurance company i.e. the primary or the secondary or the tertiary insurance companies didn't make a payment for a particular bill, this amount would have to be paid by the patient themselves.
The payments detailed on the EOB are posted on the application that have the codes and the billing information for the patient who visits the clinic, the procedure codes and date of service would be available as they would be entered by the counter person who takes in the appointment and enters the details of reason of visit which is the procedure code and the date of service, When the payments are posted the allowed amount by the insurance company which is predefined give an adjustment amount which would be the part borne by, the secondary insurance payment,or tertiary insurance or the patient.
Our Role
Binary Spectrum expertise in healthcare application that take control of efficient posting of claims, receivables and reclaiming payments that are received by the insurance company this helps in less paper work and file maintenance and reducing the errors, taking care of handling a limited manpower,which in return proves cost effective.
Well if you are interested in outsourcing software development or would like to find out more about our services and offerings, please get in touch with us. A senior member of our Business team will get in touch with you within 24 hours.
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