Medical_Billing_Process

The Medical Billing Process By: Amanda Bone HCR/220 September 19, 2010 John Varas In the medical billing process there are 10 steps that must be followed in order to get the work correct. In this paper I plan to explain each process of medical billing. Step one of the medical billing progress is preregister the patients. In this step there are two main tasks that are involved. One being schedule and update appointments. Second being collect preregistration demographic and insurance information. This step must be done before the patient can be seen by the doctor or doctors. Step two of the medical billing process is establishing financial responsibility for the visit. Step two is a very important step in the billing process as it determines who is responsible for the financial part of the visit. With patient’s that do have insurance there are questions that a medical insurance specialist must get answers to. First what services are coved under their plan' What medical conditions establish medical necessity for these services' What services are not covered' What are the billing rules of the plan' And what is the patient responsible for paying' Knowing the answers to these questions helps the medical insurance specialist to do their job. Step three of the medical billing process is checking in the patient’s as patient of the practice. For new patients detailed and complete demographic and medical information is collected at the front desk. Returning patients are asked to review the information to make sure it is correct and change anything that needs to be changed in their file at that time. Also copayments are collected at the time of checking in patients. Step four of the medical billing process is checking out of the patient’s. The first task that is done at this step is to record all medical codes of the patient’s visit. When a doctor examines or treats a patient they document their findings in the patient’s medical record. In order for the medical insurance specialist to bill the visit the medical treatments and diagnoses must be given a medical code. Step five of the medical billing process is review coding for compliance. This means that all medical codes given are looked at to make sure that all official guidelines are followed when the medical codes were given to the diagnoses and treatments. Step six of the medical billing process is check billing compliance. Every charge or fee for a visit has a procedure code. Whether a code can be billed depends on the payer’s rule for their billing. Step seven of the medical billing process is to prepare and transmit claims. Preparation of medical claims is a major step in the medical billing process. Most practices prepare claims for their patient’s and they are sent in electronically. A claim contains information about the diagnosis, procedures, and charges to a payer. A claim can be for reimbursement or a report. Each practice has a schedule for transmitting claims. Step eight of the medical billing process is monitor payer adjudication. A medical insurance specialist will compare each payment with the claim to check the following: that all procedures that were listed on the claim also appear on the payment transaction, that any unpaid charges are explained, that the codes on the payment transactions match those on the claim, and that the payment listed for each procedure is correct according to the contract with the payer. Step nine of the medical billing process is generating patient statements. Payer’s payments are applied to the appropriate patients’ accounts. Most cases are that the payer’s payment does not pay the bill in full the patients are going to have to pay some of the bill for the visit to the doctor. Step ten of the medical billing process and the final step as well follow up patient payments and handle collections. All patient file are checked of overdue bills that are in need of being paid. If an overdue bill is found then the patient has a timeline to pay the bill in full before the collections process beings on the patient’s overdue medical bill. There are ten steps total to the medical billing process and each step has different things that must be done and followed in order for the billing process to go smoothly and is done correctly. References Axia College. (2008). Introduction to the Medical Billing Process. Retrieved from Axia College, HCR/220 website