Medical Billing Software

Turn up your medical billing cash flow with Electronic Claims submission. EzMedPro is fully integrated with Clearing houses to automatically submit the claim file or upload the files to clearing house web sites.
Choose your Clearing House

EzMedPro Practice Management Software contains Medical Billing Software and is fullt integrated into one system. Medical Billing is the process of submitting claims to insurance companies and collecting payments for rendered services.

Electronic Billing

Medical Practice are now required to be HIPAA compliant and send their claims electronically.

Healthcare Eligibility

Prior to performing a service and billing a patient, the provider shall verify the eligibility of the patient to receive benefits for the intended services from the insurance company.This process currently uses X12-270 (Health Care Eligibility and Benefit Inquiry ) to send insurance information and the response is provided in X12-271 (Health Care Eligibility and Benefit Response) transaction

Insurance Claim

The provider sends a claim for a service for each patient's visit. The claim contains large amount of data that pertain to the interaction with the patient as well as information about the patient, the provider and the practice. The claim is sent in a transaction known as X12-837. The payer or the clearing house will response with acknowledgement that the claim is received. When the claims are actually processed by the insurance company, the insurance will ultimately respond with a X12-835 transaction, which shows the line-items of the claim that will be paid or denied; if paid, the amount; and if denied, the reason.

HCFA Form

The HCFA form is still largely used when electronic billing is not available. The HCFA form capture the details of provider's rendered service and is send by mail to the insurance company.

Payment Management

In order to be clear on the payment of a medical billing claim, the healthcare provider must have complete knowledge of different insurance plans that insurance companies are offering, and the laws and regulations. Large insurance companies may have up to several different plans contracted with one provider. When providers agree to accept an insurance company’s plan, the contractual agreement includes many details including fee schedules which dictate what the insurance company will pay the provider for covered procedures and other rules such as timely filing guidelines. Providers typically charge more for services than what has been negotiated by the doctor and the insurance company, so the expected payment from the insurance company for services is reduced. The amount that is paid by the insurance is known as an allowable amount. The difference is called a "provider write off" or "contractual adjustment." After payment has been made a provider will typically receive an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) along with the payment from the insurance company that outlines these transactions. The insurance payment is further reduced if the patient has a copay, deductible, or a coinsurance. The doctor is then responsible for collecting the out-of-pocket expense from the patient.