The Ten Steps in the Medical Billing Process

medical billing cycle steps

You can file an appeal, asking the insurance provider to reconsider its decision. If a third-party reviewer decides to favor the client, the health insurance company will pay for the treatments or services rendered. The first step is to collect patients’ demographic and insurance information, including name, age, address, contact, policy number and insurance provider.

If there are any discrepancies, the biller/provider will enter into an appeal process with the payer. This process is complicated and depends on rules that are specific to payers and to the states in which a provider is located. Effectively, a claims appeal is the process by which a provider attempts to secure the proper reimbursement for their services. This can be a long and arduous process, which is why it’s imperative that billers create accurate, “clean” claims on the first go. A rejected claim is one that the payer has found some error with. 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.

How to Become a Medical Billing Specialist

To be more specific, the front desk personnel passes out a form to the patient to gather information. Every business has its method or process that helps it to be profitable. Similarly, medical medical billing cycle steps billing firms adhere to a distinct procedure to remain ethical and commercial in the marketplace. Therefore, medical billing services include Revenue Cycle Management as an essential component.

medical billing cycle steps

They won’t send the full cost to the payer, but rather the amount they expect the payer to pay, as laid out in the payer’s contract with the patient and the provider. Gathering this information requires billers to review patients’ medical charts and insurance plans to verify coverage of services. They then generate medical claims, check for accuracy, and submit claims to payers.

Statement Follow-Up

If the patient is for their first visit, they should give personal and insurance details to the provider to confirm that they are granted to have services from the provider. Demonstrated ability to validate medical claims data on forms and prepare them for submission to clearing houses. Have you ever received a medical bill in the mail for services from a doctor’s office or hospital? Chances are that the bill was created by a medical coding specialist.

Medical billing specialists are trained professionals, skilled in the medical office billing process. All medical tests are given a special code that is known by the medical provider and the insurance companies. With the reference to the payment posted to the practice accounts including patient and insurance revenue will be calculated.

Strategies for improving the accuracy and efficiency of the medical billing process

… Most of them are going to pick up that primary one.” Be sure you are pointing the diagnosis correctly to justify the procedure that was done. Bear in mind that there is a difference between “front-of-house” and “back-of-house” duties when it comes to medical billing. Medical billing might seem complicated, but it doesn’t have to be. In this video, we’ll learn more about this process by breaking it down into a handful of easy-to-understand steps. Many industries, including health care, had to revise their plan of action to run their businesses.

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Run these reports by the DOS rather than the date of post, Daily said. Use the reports as staff learning tools, set up goals, and make staff accountable to fix errors hurting your practice’s revenue cycle. When working on A/R, start with time-restricted carriers, then go to the largest outstanding balance.

Verify Patient Insurance and Fiscal Responsibility

While each medical office’s procedure may vary somewhat, below is a broad overview of a medical billing system. Elation provides revenue cycle management software and services for independent practices of all sizes. Our integrated medical billing solution allows you to maximize your revenue so you can focus on your patients. The final step of the medical billing process is making sure the bills get paid! If patients are late in paying their bills, it’s important to contact them directly or send follow-up bills.

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