A claim is often considered the most valuable source of data and information for a healthcare company or organization. All of the claims that are submitted to payors contain procedure information and diagnosis information to make the patients’ visit billable. But, what is a medical claim? In layman’s terms, this is a bill that a healthcare provider submits to a patient’s insurance provider, it contains the medical codes that detail the care administered during the patient’s visit. These codes describe the services the provider administered when seeing the patient. These often include:
In the claims submission process, all relevant medical coding and corresponding charges are included. The insurer will assess all medical codes and diagnoses to determine if the provider will be reimbursed and how much to pay for their services. So, what does the medical claim look like? And, what information does it contain? In simple terms, it contains details specific to the patient and their encounter with the provider. This is usually split into two areas, the claim header and claim detail.
That’s a lot of information to take in, but there’s also an entire process that follows a medical claim. What is the medical billing process? There are several steps in the revenue cycle that must occur to result in reimbursement.
The Gables Medical Billing team of medical billers is ready to handle all claims submissions, follow-ups, appeals, and payment postings with the dedication that your revenue cycle demands.
Gables Medical Billing has adapted to the ever-changing medical billing environment, modifying and adding to its services to proactively meet the needs of its clients.