The medical billing process is a matter that should be straightforward: a provider utilizes standardized medical coding to inform the payer of the services rendered, and that payer, usually the insurance company, and the patient are responsible for paying their portions. However, the reality is that those costs are virtually never set in stone.

While software is commonly used by the entity processing the claim, there is not a universal software that those paying claims utilize.

Instead, each insurer negotiates for lower prices with each hospital and doctor on every plan. The negotiated prices even can vary within an insurance company depending on which plan a patient has.”

Thus, ensuring that medical billing is fair, is a truly difficult feat even for the most experienced within the industry.

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Explanation of Benefits (EOB)

Explanation of benefits is a document submitted by most insurance companies, which explains to individuals what treatments and procedures were paid on their behalf by the insurance company. EOBs are typically physically connected to a check or a statement that also verifies the payment that has been made by the insurance company.

EOBs are important, because in many cases they are what dictate whether or not a claim was approved. If a patient is not familiar with the language of medical billing statements, or there is coverage that falls under a gray area, it becomes dangerously easy for a lack of transparency and accountability to develop.

What Happens When Medical Bills Aren’t Paid

The unfortunate reality is that the entire system is complicated by the fact that healthcare can potentially be a highly lucrative field. Thus, there is much incentive for insurance companies not to approve claims and for the patient to do all they can to avoid being overwhelmed by the financial burden.

When Insurance Doesn’t Pay

An important component is ensuring that all involved are able to recognize what should be happening, so they can determine when it’s not happening. For providers this means having the expertise needed to navigate both the billing process as well as how insurance companies respond to claims.

For patients this means that they are prepared to understand their EOB and what rights they have to negotiate and to challenge bills determined by their insurance company.

Managing the billing process accurately is not easy as providers might face hurdles in revenue cycle management. Moreover, Net Collection Rate below 95% shows that your practice is facing troubles in the billing process. To eliminate all these hurdles and maintain your NCR up to 96%, MedsIT Nexus Medical coding Services are around the corner for you so that your practice does not have to face a loss.

When insurance companies don’t pay, the vitality of an organization is at risk. Past-due receivable services can be vital for the health of a provider and to, “expedite cash flow and maintain good financial health.”

Even the most experienced of providers would do well to utilize professional, experienced legal help to ensure that insurance companies pay the portion of claims they are responsible for.