Inter dependency of Healthcare providers and insurance companies

            A healthcare provider is a person which introduces various healthcare services like preventive, curative, promotional or rehabilitative to an individual or a community.  It can be a surgeon, obstetrics, dentist, nurse, pharmacist, psychologist or any other allied health professional. Healthcare providers and insurance claim are the two important terms nowadays, both are interdependent on each other. Insurance company is an entity with equitably transfers the risk of loss between other entity in exchange of money.

Relationship :

              The relationship between the healthcare providers and insurance companies can be explained as vendor and subcontractor. The healthcare services are provided after the contract has been made between healthcare providers and the insurance companies. It all starts with a visit to the physician’s office or merely by meeting the staff, followed by getting update on the patient’s health record. After examining the patient the physician provides the diagnosis and procedure codes which helps insurance company determining the insurance claim.

Services :

          The healthcare examiners assist the insurance companies in processing the claim. After approval the claims go through several billing services. For few years the entire process was executed on paper, as a result which gave lots of errors and difficulty in handling claims in large amount, hence the term was introduced “Medical Billing Outsourcing”, to avoid this load the billing is outsourced to the third also known as Medical billing services. A part of the revenue generated by practice was taken by these billing services as payment. It was done to achieve to goals first to reduce the burden of paperwork and increase the efficiency which was reduced because of workload surfeit. Another major reason to opt this method over normal way of medical billing is the difficulty of keeping staff and billing systems up to date as latest billing rules becomes a distraction for health care providers and executives.

             The expertise of billing is the mind and this method of outsourcing is body as it’s their responsibility to study the case and process the provider’s claim   properly to maximize insurances payment. They are the one who are responsible of taking codes and preparing bills without errors as it is to be further forwarded to the insurance companies now it’s the task for expertise of medical billing to execute the billing process so that the denials of insurance companies is avoided. Trend is also another factor of medical billing outsourcing as it reduces the cost in potential manner.