Health Care Bill is also known as Medical Bill, It is the bill which billing companies or provider going to bill the insurance companies, for reimbursing the payment for the services provided to the patient by health care professional.
It is the treatment given from Health Care Professional to improve or maintain the patient health.
There are 3 main P’s in this industry:
Patient: Is the one, who is in need of Health care services.
Provider: The individual or the organization that provides services to the patient.
Example: Clinics, individual doctors, hospital and laboratories.
Payer: The individual or organization, which pays for the services given to the patient.
Example: Insurance companies, Uninsured patients and companies in case of workers comp.
In United States the Health Care expenses are very high. So almost more than 90 percent of Citizens have health care insurances.
Health Care insurance can be mainly Classified into two types:
- Traditional Care Plans
- Managed Care Plans
Types of Health Care Bill:
Professional Billing: Which is the service done by a Doctor and is usually billed in a CMS 1500 / HCFA form.
Technical Billing: Which includes the services other than that given by the Doctor and is usually billed in CMS 1450 / UB 92 forms.
Now let us discuss about ways of submitting health care bill to insurance companies.
There are two types of submitting a Health care bill or Claims
- Paper Claims
- Electronics Claims
Paper Claims: It is the one submitted on paper, this is directly mailed to the insurance company through ordinary mails.
Electronic or E Claims: These are Electronic Version of the claims which are sent through a Clearing House by the Billing Office before forwarding it to the insurance company.
Once we submit the health care bill, insurance company start adjudicating the claim.
The Health care bill that have successfully come out after checking the errors will be adjudicated or processed and it is in this stage that the insurance company decides whether to pay or deny the health care bill.
If they want to pay the health care bill, they decide how much to pay based on the patients plan and the providers contract. Once insurance company processed and paid the claim, the remittance advice or EOB will be issued to the physician and patient. This EOB will contain the payment details, which include the Processed Date, Billed Amount, Allowed Amount, Contractual Adjustment, Paid Amount, Cheque#, Patient’s Responsibility, Claim# and so on.
If it is a denial also, insurance company will notify the patient or provider with remittance advice or EOB.
EOB contains Denial Date, Denial code, Reason for Denial, Claim# and so on.
Conclusion: I hope you have understood about the health care bill, which we submit to the insurance company to get reimbursed for the services provided to the patient by provider services.