Steps in Medical Billing
The processes of medical billing used in healthcare, providers and insurance companies have to submit and follow ups in order to receive payments from the medical services. Ten steps are used to complete the medial billing process. There are three categories which is visit, claim, and post claim.
Visit makes up the first categories that consist of the first four steps. Pre-registering the patient is the first step in the visiting area. The two main tasks of pre-registering are schedule and update appointments and collect pre-registration demographic and insurance information. When patients call for an appointment they provide their personal and insurance information for the scheduler. Also the scheduler will ask if you are a new or returning patient.
The first step is to pre-register the patients and get all of their contact information ...view middle of the document...
Check in patients is step three. At the arrival of the patient, the clerk need detailed and complete demographic and medical information. Returning patients would look over their files to make sure it is up-to-date and past due bills owed. The patient’s identification is scanned in put into the patient’s record. Making sure any copayments is needed during the service. The final step of visit is check out patients. The first task in checking out the patient is to record the medical codes of the visit.
The fourth step check out patients and give them all their prescriptions, lab slips or referral paperwork they might need and set up a follow up appointment if necessary
The fifth step review coding compliance then obtain CPT and ICD-9 codes from the doctor(s) and verify that all information is correct before entering it into the computer system
The sixth step check billing compliance makes sure each code is not billable, whether a code can be billed depends on the payer’s rule. Following the rules when preparing claims results in billing compliance. Medical insurance specialist must apply their knowledge of payer guidelines to determine what can be billed and what cannot be billed on health care claims.
The seventh step prepares and transmits claims also this is now mostly done electronically and also involves receiving acknowledgement of receipt by the insurance companies or the clearinghouse that forwards the claims from you to the insurance companies.
The eighth step is to monitor payer adjudication and maintain an aging report which shows all outstanding claims in columns based on how many days old they are (30 days, 60 days, 90 days, etc.). Call, resubmit and do anything else necessary to get the claims paid.
The ninth step generates patient statements and prints statements every month and send to the patients
The tenth step follows up patient payments and handle collections also indicate if a statement has been sent to the patient.