Insurance Billing Guidelines

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Medical service providers as well as insurers have billing guidelines that are used when processing bills for insurance. This can include sending a bill for payment, collecting fees at the time of service and receiving a explanation of benefits document. Insurers and medical providers also use codes for types of services when processing a bill that is sent to an insurer to pay their portion of the costs.

Deductible and Co-Pays

Doctors, physicians and specialists often require payment when services are rendered. These payments can come in the form of a deductible or co-payment that is owed by patients for their portion of their health care costs. Many times a deductible and co-pay can be billed to patients instead of paying the fee at the office. Individuals will then be required to send the required payment when a bill is received.

Self-Payments

Individuals might be between insurance coverage or have an outstanding balance after payment was made by an insurer. Many medical providers offer payment options that can be used if the full amount due cannot be paid within 30 days after a bill has been received. Patients, in some cases, can make arrangements to pay an outstanding balance within 90 days without any additional fees or interest.

Billing Requirements

Most types of medical providers will need to collect information from an individual before services are performed. This will include providing insurance information that is typically included with an insurance card or certificate. Medical providers will usually make a copy of all insurance cards or required information that is supplied. As a courtesy many providers will also file a patient's insurance so payment is sent quicker.

Explanation of Benefits

When a medical provider sends a bill or files information with an insurer an explanation of benefits (EOB) will be sent to the insured. These documents detail the procedures or services that insurers owe for their share of medical costs. An explanation of benefits document will have a description of the service that was provided and the cost, if any, that an insured will be required to pay. Patients will need to contact their insurers for any discrepancies on the EOB.

Medical Codes

When a medical provider sends a bill or insurance information to an insurance company, codes are used for each type of service. Codes streamline the billing process be using a code to indicate a specific charge or service. Codes are required for certain types of insurance, such as those provided by federal HIPAA laws. Codes are typically available for medical providers from sources such as a physician or medical association.

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