4 The American system absorbs more in unrecoverable costs due to fraud each year than the entire Canadian healthcare system costs to run! Higher costs mean less affordability and less coverage—a real thing that’s happening. The creeping loss of health insurance coverage year-over-year portends a disastrous outcome for the health and welfare of tens of millions of Americans if we don’t act. It is not uncommon for nurses or physicians to also manually review these claims during this process. Medical records may be requested to compare the claim with the medical documentation. This can be conducted for any type of procedure but most commonly with an unlisted procedure to determine medical necessity. This creates a better patient experience and eases pressure on call center staff by removing the need for multiple time-consuming phone calls. The final phase of the healthcare claims processing cycle is the generation of the patient statement. The patient statement provides the patient clear documentation of the amount charged. The patient statement informs medical billing process the patient of any remaining balance, so that patients are notified of what unpaid amount they are responsible for. The final and most crucial part of the medical billing process is guaranteeing those […]