The 10 Steps in the Medical Billing Process

Using the proper canons is pivotal because using the wrong one could significantly change the charges. In this case, your billing team should review the payer’s decision, which will often be detailed, for potential inaccuracies. If you spot any errors, you can begin the appeals process, though it can be costly and lengthy. It’s the biller’s responsibility to confirm that the provider is properly reimbursed for their services when the patient is irresponsible in their payment or if they don’t pay the full payment. This may involve contacting the patient directly, sending follow-up bills, and if it isn’t working would, hire a collection agency. The medical biller usually initiates a set of processes, If a patient doesn’t pay his or her bill within the correct time period.

Once the claims are submitted, medical billers closely monitor their progress. They track the claims’ status, ensuring they are received and processed by the insurance companies or payers. In case of any rejections or denials, billers promptly address the issues and resubmit the claims with the necessary corrections. Moreover, charge entry also contributes to compliance with healthcare regulations and guidelines. By adhering to the correct coding and billing practices, healthcare providers can avoid penalties and legal issues.

Register Patients – Very 1st step of the medical billing process

To offer more detailed information about the process or the service, use CPT and HCPCS code modifiers. Only armed with relevant codes and modifiers can the insurance payer make up a proper evaluation. This information is the foundation of a medical claim for rewarding healthcare practitioners. The errors or discrepancies between entered data and your company’s data can be addressed swiftly. When it is time to pay these bills, the errors will not affect your medical billing cycle.

• Simplifying the payment process for your patients helps encourage payments in full and on time.
• This is when your team, or your medical billing service provider, sends everything over in an orderly fashion to the adjudicating entity (i.e. Alberta Health / ACHIP).
• This encoded information can be understood by all insurance companies and medical providers, and is used to generate bills and track payments.
• The goal is to ensure all claims are thoroughly reviewed and processed promptly.
• If the payer denies payment, the medical biller contacts the patient to inform him he is required to pay the remaining balance.
• If a claim is missing important patient information, or if there is a miscoded procedure or diagnosis, the claim will be rejected, and will be returned to the provider/biller.

Now is a terrible time to realize they don’t have coverage when they thought they did. Ensure all fees are listed along with the appropriate codes for the visit. By having a clear itemization of medical services, you’ll reduce errors and streamline the process. Any mistakes here could lead to denial of claims and non-payment or reimbursement from the insurer. Denial of claims can occur when insurance companies refuse to pay for services that were rendered. This can be due to errors in the billing process, incorrect coding, or lack of coverage.

CDT® (Code on Dental Procedures and Nomenclature)

The patient will also be required to provide some sort of official identification, like a driver’s license or passport, in addition to a valid insurance card. Denials or reimbursement problems should be worked as soon as they are received from insurers. When a payer denies a claim, the remittance advice provides billing staff with a denial code(s) and a brief explanation as to why the claim was denied.

Alternatively, you can outsource this work to a medical transcription service. Electronic Medical Records (EMR) are the electronic version of patient medical reports or charts that includes information like the patient’s treatment, diagnosis, procedure, lab reports, etc. In short, it details what happened during the patient’s visit to a Medical Practice or Hospital. EMR helps physicians track patient accounts and follow-ups accordingly, identify patients due for check-ups and schedule them for screening or regular check-ups. A clearinghouse accepts and rearranges claims from medical billers and transmits them to payers.

Step 5: Preparing and Submitting Claims

It also enables healthcare providers to accurately estimate the cost of services and provide patients with upfront cost estimates, promoting transparency and avoiding unexpected medical bills. It requires a high level of attention to detail, knowledge of coding and billing guidelines, and effective communication with insurance medical billing process steps companies and patients. Without effective medical billing, healthcare organizations would struggle to receive proper compensation for their services, which could ultimately impact patient care. Despite the importance of medical coding and billing, there are several challenges that medical coders and billers face.