Medical billing is a process of preparing medical bills for healthcare services providers to get them reimbursed for the services they provide to patients. To prepare medical bills, a medical billing professional collects all the required information including patient demographics, clinical services provided, insurance details; compiles medical bills and sends them to payer for reimbursements.
We can easily identify different stages of medical billing process and procedures.
Medical billing process starts from the front desk. As soon the patient calls, the front desk officer will search for the patient demographics if the patient has already been registered. If no prior information about the patient is found then patient’s demographic information needs to be entered carefully which includes name, address, SSN, insurance information and the reason for the visit. Entering patient’s demographic information at front office requires extreme care and accuracy because any error or mistyped information on this stage can cause problems later on when submitting the medical bill.
Insurance Eligibility Check and Authorization
As soon the patient provides insurance information and the reason for visit, it is now one of the most important stages of medical billing process that is to check for the eligibility of the patient for medical services. There are multiple types of insurance plans and all of them differ in various ways. It becomes even more complex when government run health insurance programs also differ from states to states. So, it depends on the type of insurance plan patient is registered with which determines that what medical services have been authorized by the insurance carrier. At this stage, if a medical billing professional finds that the required medical service is not authorized then it should be clearly communicated to the patient that the service is not authorized and the medical bill would be personally paid.
When the patient arrives for the scheduled appointment, the front desk officer continues with confirming the information which can be insurance card and verification with a personal ID. At this stage, if the patient is not covered by the insurance or partially covered, the medical biller would calculate the bill or copay after the checkup.
There are two types of medical codes used to prepare medical bills: ICD-10 (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. ICD codes are used to describe the patient’s diagnosis and CPT codes narrate the clinical procedure performed by the physician. After the patient check-out, all the information of the visit is sent to a medical coding professional who assigns the procedure codes. Accurate CPT and ICD codes are imperative to claim the payments from the Payers. Insurance carriers check for the accuracy of the procedure codes and modifiers, insurance claims get rejected if the diagnosis codes do not correspond to the procedure performed. Expert level understanding of medical coding is a must to properly compile medical bills, which is why medical coding and billing resources are trained professionals who can accurately transcribe the details of a patient visit into standard codes.
Charge entry is the stage in medical billing process when medical billing professionals assign the assign the dollar value as per the service fee. It is another important phase where a medical biller determines the exact value of the service provided. The charged fee should accurately reflect the codes and service provided; any misappropriation or overcharged entries can result in the denial of the payment.
Once the medical billing professional confirms the accuracy of the claims, they become ready to submit. Mostly, medical claims are submitted electronically and insurance companies have a different schedule for claim submission. At this stage it’s necessary that all the requirements of the payer are met, the claims are then processed.
Medical Billing and Collection Process
Medical claims adjusters examine the claims and release the payments after a certain time period or if they find some issue with the claims, they send it back with the reason of the rejection. It is again now the responsibility of the medical biller to rectify the problem, make corrections and resubmit it to complete the medical billing and collection process.
Making sure that provider has been justly paid is the last stage in the medical billing process. If the payment matches the claim, they are posted or the remaining balance is billed to the patient.
To know more about our medical billing process, please talk to our Medical Billing and Coding Specialists