Similar to medical coding, medical billing appears to be a lengthy and complex procedure but is actually just basic stages. Included in these steps are registration, establishing financial responsibility for the visit, checking for coding and billing compliance, checking for payer adjudication, preparing and transmitting claims, generating patient statements or bills, assigning patient payments, and setting up collections.
Patient registration and proof of financial responsibility
A patient essentially preregisters for their visit to the doctor when they phone to make an appointment with a healthcare professional. If the patient has previously seen the practitioner, their information is already on file. Therefore, all they need to do is state their purpose for visiting. In order to confirm that a patient is qualified to receive services from the provider, a new patient must supply personal and insurance information to the provider. Financial accountability specifies who is responsible for paying what for a certain doctor’s appointment. The biller may then identify whether services are covered by the patient’s insurance plan after they get the necessary information from the patient. This is how medical billing works.
Patient registration and discharge processes
Both patient check-in and check-out are front-of-house processes that are not too complicated. If this is the patient’s first visit to the provider, they will be asked to fill out some paperwork, or if this is not the patient’s first visit, they will be asked to verify the information the doctor already has on file. Along with a current insurance card, the patient will also need to present some form of government-issued identification, such as a driver’s license or passport. The medical coder receives the patient’s medical report after they have left the facility and abstracts and converts the report’s data into precise, usable medical code. The “superbill” is the name given to this report, which also contains demographic data and details about the patient’s medical history.
Preparation and transfer of claims
The medical biller receives the superbill from the medical coder and enters it into the appropriate practice management or billing software or onto a paper claim form. The price of the treatments will also be included by billers in the claim. The amount they anticipate the payer to pay, as specified in the payer’s contract with the patient and the provider, will be sent to the payer instead of the entire cost. All health entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are obliged to file their claims electronically, with few exceptions. HIPAA covers the majority of payers, clearinghouses, and providers.
Final processes
A claim goes through an adjudication procedure after it is received by a payer. When a medical claim is adjudicated, a payer assesses it, determines if it is legitimate or compliant, and, if so, determines how much of the claim the payer will pay the provider. A claim may be approved, rejected, or refused at this point. It is now time for the biller to create the patient statement after receiving the payer’s report. The statement is a bill from the provider for the operation or procedures the patient underwent. The leftover sum is given to the patient after the payer has agreed to pay the provider for a portion of the claimed services. Making sure the bills are paid is the last step in the billing process. It is the responsibility of billers to send out correct, timely medical invoices and to follow up with patients whose payments are past due. When a bill is paid, the payment details are kept in the patient’s file.