Medical billing process seems to be more complicated than it should be. It is simple and easy to understand the process. In this article, we will learn more about the medical billing process by breaking it down into ten steps that are easy to understand.
Medical billing is the translation of healthcare records into a billing claim. A medical biller is responsible for all medical billing services and following claims to ensure reimbursement for services provided by the provider.
Just like medical coding, medical billing might seem complicated, but it is a process that comprises ten simple steps.
Documentation of the patient’s information. The patient provides personal information like name, contacts, current insurance card, insurance number, and medical history or reports.
2. Insurance verification
The insurance information submitted by the patient at step one is verified. Insurance verification is done to ensure the patient is eligible to get services from the named provider.
The services covered by the insurance company are determined. The biller checks for the insurance coverage to remove the doubts of what is covered by the insurance company. If the insurance doesn’t cover services, the biller makes the patients aware that they will pay the entire bill.
3. Patient check-in and check out
Patients are asked to fill out some forms. If it is their first time, step 1 (Registration) comes in. If it isn’t the first time, the patient is asked to provide a driver’s license or passport and a valid insurance card. The copayment is at this stage, but it can either be before or immediately after the visit.
When the patient checks out, the medical records are sent by the doctor to the medical coder.
The medical coder translates all the information like patient’s diseases, symptoms, and medical procedures in the medical report into accurate medical codes.
5. Checking code compliance
The medical codes are cross checked to ensure no error occurred when entering them.
6. Preparing and transmitting claims
The medical coder prepares a superbill. A superbill is a medical document that contains the name of the patient, provider, and physician, procedures performed, code for diagnosis, and other important medical information.
The medical coder then transfers the superbill to the medical biller. The biller puts the superbill either in a paper claim form or billing software.
7. Auditing claim
The biller checks the document for errors and fixes all the identified errors.
8. Claim submission
The medical biller can either send the claims to the insurance companies directly or via a clearinghouse.
9. Denial management
Some claims may be delayed or rejected for one or two reasons. The payer first reviews all the received documents. If there are errors or missing information, the payer sends the document to the medical biller for correction.
The payer can also fail to make the payment if the claim doesn’t comply with what the patient and the company agreed.
The payment made by the insurance payer is received. The biller verifies it is the right amount and then updates the patient’s account. If the amount received isn’t correct, the biller contacts the payer. If the payer denies payment, the medical biller contacts the patient to inform him he is required to pay the remaining balance. Insurance companies don’t pay for services not included in their insurance policies.