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Medical billing is nothing but translating a healthcare service into a billing claim. Basically, it is the process of submitting and following up on claims with health insurance providers in order to receive payments for services provided such as testing, treatments and procedures by any health care provider. In order to make the process of medical billing right, the billers process the health insurance claims for doctors’ office, hospitals or any other healthcare facilities by entering the correct codes into patients’ electronic health records.
Pre Certification In Medical Billing
The term pre-certification refers to the process by which a patient is pre-approved for coverage of a specific medical procedure or prescription drugs. Health insurance companies may require the patients to meet certain criteria before extending some facilities and might need the doctors’ notes or any results having the patients’ history written in it. Pre-certification also refers to the notification sent by a care provider to a he health plan stating the patients’ need of electing non urgent services. Here, the carrier determines whether a member’s plan covers the requested procedure or not. Thus it can be easily said that pre certification is nothing but a request for coverage or a request to authorize a procedure covered by the insurance plan but requires prior permission.
Pre Certification Process
Pre certification is such a process that begins with a designated person employed by the health plan completing an initial review of the patients’ clinical information to make sure the requested services meet the set guidelines and if it does, the designated person authorizes the request and the health plan will cover the service, but if the service does not meet the guideline, the requested service is referred to senior levels to decide the approval or denial of the request based on the information. The chances of getting the request pending upon the demand of some extra documents can be arranged by the providers. Thus, this process of pre certification in medical billing might disrupt patient care by several process delays.
Pre Certification Tips
Thus to improve the speed of the precertification process and get the desired results, a person can go through some tips like becoming familiar with evidence based clinical guidelines for common conditions or asking the health insurance providers for their guidelines if the licensing agreement allows them to do so. Submitting legible documentation stating the clear reason for the requested service is the most needed thing to be performed followed by the follow up job with the health plan which is to be done if it has not responded in a timely manner. Most of the health plans are required to follow standards such as the precertification decisions must be made within 15 days from the receipt of request, if the request is not urgent though.
Thus, it is clear that precertification services medical billing in its own way but in order to get the job done timely and without any inconvenience, the above mentioned criteria should be taken care of seriously by the patient parties