Uderstanding_the_Patient_Intake_Process

Steps in the Medical Billing Process Deborah Carmichael HCR/220 July 11, 2010 Allen Chighizola, MBA, S.S.P. Steps in the Medical Billing Process There are several steps in the medically billing process. These steps should be followed to ensure appropriate, timely payment for patient’s medical services. Further, these 10 steps help provide more billing accuracy for medical service providers. The first step is to pre-register the patient. This procedure involves collecting current information, such as, address, phone number, and updated insurance information. After this is done appointments are scheduled. In the next step it is the medical insurance specialist responsibility to determine the financial responsibility the patient’s visit. When the patient has insurance there are questions that must be asked. • What services are covered under the plan' Why does the patient need this service' • Are these services covered' • What billing rules refer to the plan' • What is the patient’s responsibility for payment' These questions are necessary to ensure proper billing of the patient’s covered services. This also helps the medical insurance specialists on what to bill the patient when benefits do not apply. To determine financial responsibility these procedures are followed: • Verify patient’s responsibility for their health plan • Check the health plans coverage • Check if patient has more than one health plan. If so then the first health will be billed. • Follow payer’s instruction for payment such as, preauthorization. The third step is to check in-patients when they arrive for their appointment. If the patient is new, demographics for the patient must be collected at the front desk. Returning patients should be asked to review demographics and medical data to make sure it is up to date. Financial records should be checked to make sure no balances are due. Insurance cards, and photo Id’s should be copied and put in the patient’s file. Also, co-payments should be collected at the time of service. In addition, there are forms that should be filled out by the patient. These forms are a part of the process of recording clinical and administrative facts about the patient. The fourth step is checking out the patient. The first task in this step is to record medical codes for the visit. When health care professionals examine or treat patients, they document the patient’s diagnoses and procedures in medical records. To bill for the visit, the medical procedure, or treatment, must be assigned a code. A physician, or a medical coder can assign these codes, or a medical insurance may handle this task. The medical insurance specialist verifies these codes with the data in the patient’s medical record. Each procedure the physician performs is assigned a procedure code. Step five is reviewing coding compliance. This means satisfying official requirements. Coding compliance further entails following official guidelines when codes are assigned. When codes are selected they must be checked for errors. Medical services that are document must be logically connected, so that the payer understands the necessity of the charges. Step six is checking billing compliance. Each charge or fee is related to a specific billing code. Provider’s fees are listed on the medical practice’s fee schedule. Most medical practices are standard. There is a separate fee associated with each code, however each code is not necessarily billable. Billing for the code depends on the payer’s rules. Following these rules when preparing claims result in billing compliance. Step seven is preparing and transmitting claims. This is a major step in the billing process. This step ensures accurate, timely health care claims. Most practices prepare claims for patients and send them electronically. Claims communicate information about the diagnosis, procedures, and charges to payer. Each practice has a schedule for transmitting claims, daily or every other day. Step eight is monitor patient adjudication. It is important to collect payments as soon as possible. The money due from plans and patients are known as accounts receivable. These payments are used to run the practice. Plans reviewed by payers are known as adjudication. This means that the payer puts the claim through a process to see if it should be paid or not. Step nine is generating patient statements. Payer payments are applied to patient’s account. In most cases, this does not fully satisfy the bill. Patients will be billed for the rest. All of the amounts paid and billed should equal the expected fee. Step Ten involves payments and collections. In the medical office, analyzing patient payments for overdue bills must be performed regularly. In the case of a late payment, it is considered overdue once it has passed the limit specified in the practice’s financial policy. The collection process will begin upon indication. In regards to patient medical and financial records, they are filed and retained according to the practice’s policy. How long and which records are kept is regulated by federal and state governments.