Billing in healthcare is a crucial but often misunderstood process. To get a handle on your facility’s billing system, it is important to understand the three different types of billing systems in healthcare – closed, open, and isolated. By understanding the strengths and weaknesses of each system, you can make an informed decision about which type of billing system is right for your facility. Here’s a breakdown of the three different types of billing systems in healthcare:
The 3 Different Types of Billing Systems in Healthcare
Healthcare billing systems can be classified into three different types: closed, open, and isolated.
1. Closed Billing System
In a closed billing system, the provider (healthcare facility) and the payer (insurance company) have a contract that outlines the specific services covered and the corresponding reimbursement rates. This type of system is also referred to as a “contracted” or “participating” system. In a closed system, the provider agrees to accept the payer’s reimbursement rates as payment in full and cannot bill the patient for any additional amount.
2. Open Billing System
In an open billing system, the provider does not have a contract with the payer and is, therefore, free to set his or her own rates for services. The provider can also bill the patient for any amount not covered by insurance. This type of system is also referred to as a “non-contracted” or “non-participating” system.
3. Isolated Billing System
An isolated billing system is one in which the provider bills the patient directly for services, and the payer (insurance company) reimburse the patient directly. In this type of system, the provider is not involved in the insurance claim process at all. This type of system is typically only used for services that are not covered by insurance.
Which Billing System is Right for You?
The type of billing system that is right for your healthcare facility depends on a number of factors, including the type of services you provide, the payers you contract with, and your facility’s overall billing strategy. For instance, in the case of mental health billing software, you may want to consider an open system so that you can bill for services not covered by insurance. If you are unsure which type of billing system is right for your facility, it is best to consult with a healthcare billing expert. They will be able to help you assess your needs and make a recommendation that is best for your facility.
Now that you understand the three different types of billing systems in healthcare, you can make an informed decision about which system is right for your facility. Remember that the type of system you choose will significantly impact your facility’s billing process, so it is important to choose carefully. And, if you are ever unsure about which system to choose, be sure to consult with a healthcare billing expert to get the best advice for your facility.