Medical_Billing_Processes

The medical billing process can be a very complex and overwhelming task, even for those involved with it daily. The effectiveness can influence the finances of the company significantly, and if done right, everyone involved benefits greatly from it, but one little mistake and every aspect is in jeopardy. An individual must follow the ten steps of the billing process for effective, prompt, and accurate payments for services that are rendered. When following the steps, there is no individual step more important than the other, as they are all equally important, and must be followed in order. The first step in the process is to pre-register patients. There are two parts of this process. The first one is to collect demographic information, and the second is to schedule an appointment for the patient. When the patient calls in to set up the appointment, the receptionist begins the billing process by gathering as much demographic information as needed. If the person is a returning patient, the receptionist must verify all information to make sure it is up-to-date. When calling for an appointment, the patient must provide all required information to schedule the appointment for their individual needs. The second step in the billing process is to establish financial responsibility. You will determine if the patient’s insurance is current, and if he or she is eligible for services to be covered. During this time, you will determine if the procedure will be covered by the individual’s health insurance. You will also find out if there will be a co pay, and how much it will be. In addition, if the patient has more than one insurance plan, you have to determine which one is the primary and which one is the secondary payer. You also discuss, with the patient that they are responsible for paying any charges not covered. Third, is to check-in patients. Make sure you have all of their information correct, and at this time, you make photocopies of their health insurance cards, front and back, along with their picture ID, front and back as well. This is the time you discuss their living will or their DNR status, and have them fill out a medical history form. There are also other forms that must be filled out that will record their clinical and administrative data, as well as the HIPPA privacy act, and a consent for treatment form. Fourth and the last step in the “visit” sequence of events in the billing process are to check out the patient. The first thing you do when checking out a patient is to record the medical code for their visit. The professional responsible for the billing process must verify the codes with the data in the patient’s chart. A diagnosis code from the ICD-9-CM is assigned to the patient’s primary illness, and the patient’s account is updated. The fifth step and the first in the “claim” sequence are to review the coding compliance official guidelines must be followed to check for errors. You must be able to understand the link between the diagnoses and the procedures performed, so the payer completely understands the charges. Sixth, the medical billing professional must check billing compliance. In this step, rules must be followed to determine whether a code is in fact billable. While most practices have standard fees for services, not all of them are billable. This is why there are specialists that follow these specific rules to check the compliance of a bill. Seventh, and last in the “claim” sequence is to prepare and transmit claims. The eighth step, and first in the “post-claim” sequence is to monitor payer adjudication. The ninth step in the billing process is to generate patient statements. The last and tenth step in the medical billing process is to follow up patient payments and handle the collections. References: