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Medical Billing 101: Understanding Your Bills and Insurance Statements

two people look at a chart about understanding your bills and insurance statements

Running a behavioral healthcare organization requires more than just specialized treatment. You’re under immense scrutiny at every step of the process to try and ensure your patients are given the best possible care. Billing, coding, and insurance claims might seem straightforward but they require attention to detail. In fact, understanding your bills and insurance statements can help you explain your services and billing practices to patients, build trust with insurance companies, and ultimately improve the financial health of your organization.

Financial management and revenue cycle management are cornerstones of the Sunwave Health platform. Our integrated software streamlines the billing and coding process, making it easier for your organization to track and collect payments while also reducing errors and denials. Plus, customizable reporting structures allow for full transparency and insight into your organization’s financial health. Schedule a demo today by calling 561.576.6037.

Billing and Claiming from a Business Perspective

You may have patients from various insurance plans or even self-pay individuals. This means that understanding medical bills and insurance statements can be complex and overwhelming. However, it is crucial to have a clear understanding of these documents for the financial stability and success of your organization.

Terminology and Codes

Medical bills and insurance statements are full of industry-specific terminology and codes. It’s important to familiarize yourself with these terms, such as CPT (Current Procedural Terminology) codes for services provided and ICD (International Classification of Diseases) codes for diagnoses. These codes determine the amount your organization will be reimbursed by insurance companies.

Claims and Revenue Cycle

When a patient receives treatment, a claim is generated and sent to the insurance company for reimbursement. The process of submitting claims, receiving payments, and resolving any denials or disputes is known as the revenue cycle. Understanding this process and ensuring accuracy in billing and coding can greatly impact your organization’s financial health.

Denials and Appeals

Insurance claims may be denied for various reasons, such as incorrect coding or lack of preauthorization. It’s important to have a system in place to track and resolve these denials, as well as the ability to appeal if necessary. This can help ensure that your organization receives the proper reimbursement for services provided.

Audits and Compliance

In the world of healthcare, audits and compliance are a necessary aspect to ensure ethical and legal practices. It’s important to have systems in place to track billing and coding data, as well as regular audits of claims to ensure accuracy and compliance with regulations.

Automating the Billing Process

Human error is a common problem in the billing process, which can lead to lost revenue and even legal implications. From incorrect coding upon treatment to mistakes during data entry, manual billing processes are prone to errors. Utilizing a platform like Sunwave Health can help with:

  • General ledger (GL) segmentation – Custom rules determine transactions that are applied to an account, including claims, payments, and adjustments.
  • Automated adjustments – Automatically apply adjustments based on payer rates, including configurable rules for historical reimbursements and experiences.
  • Journal run and period closed – Get a clear picture of your organization’s financial health by quickly generating a journal run and closing the billing period.
  • Integrating with RCM – Automatically validate claims and perform utilization reviews for more accurate billing.

Our single-platform solution integrates all aspects of the billing process, reducing errors, and streamlining billing processes. This ultimately leads to improved financial health for your organization.

Schedule a Sunwave Health Demo

From understanding medical bills and insurance statements to automating the billing process, Sunwave Health’s platform offers comprehensive solutions for behavioral healthcare organizations. Don’t let billing and coding be a burden on your organization—schedule a demo online today or by calling 561.576.6037 to see how Sunwave Health can improve your financial management and revenue cycle management processes.