As if doctor bills and insurance companies weren’t difficult enough to understand, hospital billing takes the madness to a whole new level. Patients are often shocked by how high the figures are on their bills, and they can only hope their insurance will cover it.

Registration and Establishing Patient Financial Responsibility

When you make an appointment, the hospital billing process begins. It may seem cold that they want your insurance info before they even get to know you, but it is really in your best interest. After all, it would make no sense to go through a lot of introductory processing and data gathering, only to find out that your insurance won’t cover you there and you’ll need to go somewhere else and start over!

The hospital or doctor’s staff needs your insurance account numbers so they can verify that your appointment will be covered by your health insurance, and to what extent the charges will be paid. That way they can give you a heads-up and let you know how much you will be expected to pay.

With the wide range of medical plans available, there is no way to know except to check the insurance coverage of each patient. Even when there is health insurance to cover the visit, it may have limitations, including which medications and procedures it will pay for and what is excluded.

Having that information allows the physicians to make decisions that will avoid the patient getting stuck with large bills by prescribing procedures or medications that are covered.

Medical Coding for Billing and Record Keeping

When you check out at the end of your stay, a report is sent to a medical coder who translates all the diagnosis and treatment notes into the correct medical codes and enters them into a claim form. The claim is sent to your insurer, who reviews it and either pays the amount they agreed on with the hospital or sends it back with a denial or rejection, either of which means they are not going to pay it.

Instead of immediately sending the unpaid bill to you for payment, in most cases, a medical biller will review the claim to determine what caused the denial of payment, get it corrected, and appeal the denial. This often results in the doctor getting paid by the insurer after all.

Insurer Reimbursement or Negotiation

Often when an insurance company receives a bill from a hospital, they will negotiate the bill down. So knowing that is going to happen, the hospital billing starts off charging far more for services than they would if they expected to get paid the full amount. That way, after the insurer negotiates their price down, they still get almost as much as they started out wanting.

This is important information for patients to understand, because it means that in the cases where patients have a large part of the bill that they have to pay out of pocket, they may also be able to negotiate the bill down. (Remember, the initial bill was inflated in the anticipation of negotiation, so don’t be afraid to at least ask.)

Hospital Billing Varies by Institution

Another thing that is helpful for patients to know is that hospitals charge differently from one another. It may be very useful to do some price checking before you schedule an appointment. There are a few online resources that will tell you about how much each hospital in your area charges, but for the most accurate information, you will probably need to call and ask about the cost when you know you have to have a procedure soon.

Don’t be afraid to do some negotiating of your own before you make a decision where to go. If a nearby facility offers the same service at a much lower price, your chosen hospital may be willing to match them, or at least give you a break.

Medcare MSO serves medical providers, labs and imaging centers with outstanding medical billing and revenue cycle management (RCM) services. If you are a provider of any size and are interested in outsourcing your medical billing, give us a call today at 800-640-6409.