Medical Billing Process Essay

Medical Billing Process Essay

Specialists in medical insurance address all jobs that administrative staff members complete in the medical billing process. Medical insurance specialists make sure that all duties are completed by following a ten-step medical billing process. Medical Billing Process Essay
The process??™s first step is the preregistration of patients. This is done by scheduling and updating appointments, as well as collecting demographic and insurance information prior to a patient??™s registration. When a patient calls and requests an appointment, that patient has to provide information about his or her insurance as well as some basic information, including the reason he or she is requesting an appointment.

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The process??™s second step is the establishment of financial responsibility for the patient??™s visit. For patients that have health insurance, the medical insurance specialist must determine the services that the plan covers, the plan??™s billing rules, and how much the patient is left with the responsibility to pay. Knowing this information helps the office send the correct bill to the health insurance for the services that it will cover, as well as making sure that patients pay for their portion when services are not covered.
Checking in patients is the third step in the process. Patients who are new to a doctor or practice must complete medical and demographic information. Returning patients must be sure that their information is up-to-date. Copies of identification cards and insurance cards are taken and placed in patients??™ charts. If a copayment is required, it is collected when the service is rendered, either prior to or after the patient sees the physician.
Checking out patients is the process??™s fourth step. The first part of it is to record the visit??™s medical codes. Medical Billing Process Essay If the patient sees the doctor, the diagnosis/diagnoses are documented in the patient??™s file. For payment to be made for these procedures, medical codes must be assigned. The primary illness of the patient is given a diagnosis code, and then each procedure performed by the doctor gets a procedure code.
The medical billing process??™s fifth step is the review of coding compliance, which means that actions satisfy the official requirements. Reviewing coding compliance means that employees follow guidelines in the assignment of codes. These codes must be checked for errors so that the payer is able to understand why the charges are medically necessary.

Checking billing compliance is the sixth step. Not every code is billable??”the payer??™s rules determine whether a code is billable. If the rules are followed when preparing claims, billing compliance results. Specialists in medical billing have to use their knowledge of payer guidelines for determining whether codes are billable or not.
The preparation and transmittal of claims occurs next. Preparation of health care claims must be timely and accurate. The claim relays information to the payer about diagnoses, procedures, and chargers. The claim can report a visit to an HMO or it can ask for reimbursement for services rendered.
Next is monitoring payer adjudication. After the health plans have received health care claims, payment should be collected as soon as feasible because the medical practice needs the money from the plans in order to run their business. The word ???adjudication??? means that the claim passes through a series of steps that the payer has designed in order to determine whether a claim should be paid.
Generating patient statements is the ninth step in the process. After the payer has made the payment requested, the amount is applied to the patient??™s account with the provider. Usually the payments received by the provider do not settle the bill; the patient is billed for the remainder outstanding. Medical Billing Process Essay When a patient receives a bill from the provider, the dates and services provided are listed, as well as the payments made by the insurance and the remaining balance.
The final step is following up on payments made by patients, and if payments are not made, handling collections. All patient accounts are reviewed for bills that are overdue. If a bill is past due, the collection process begins. Financial records and patients??™ medical records are filed and kept according to the policy of the practice.
It is very important that the medical billing process be followed properly so that the practice gets paid. Every step of the process contains three parts: following all procedures; effectively communicating; and understanding information technology.
Specialists in medical insurance address all jobs that administrative staff members complete in the medical billing process. Medical insurance specialists make sure that all duties are completed by following a ten-step medical billing process.
The process??™s first step is the preregistration of patients. This is done by scheduling and updating appointments, as well as collecting demographic and insurance information prior to a patient??™s registration. When a patient calls and requests an appointment, that patient has to provide information about his or her insurance as well as some basic information, including the reason he or she is requesting an appointment.
The process??™s second step is the establishment of financial responsibility for the patient??™s visit. Medical Billing Process Essay For patients that have health insurance, the medical insurance specialist must determine the services that the plan covers, the plan??™s billing rules, and how much the patient is left with the responsibility to pay. Knowing this information helps the office send the correct bill to the health insurance for the services that it will cover, as well as making sure that patients pay for their portion when services are not covered.
Checking in patients is the third step in the process. Patients who are new to a doctor or practice must complete medical and demographic information. Returning patients must be sure that their information is up-to-date. Copies of identification cards and insurance cards are taken and placed in patients??™ charts. If a copayment is required, it is collected when the service is rendered, either prior to or after the patient sees the physician.
Checking out patients is the process??™s fourth step. The first part of it is to record the visit??™s medical codes. If the patient sees the doctor, the diagnosis/diagnoses are documented in the patient??™s file. For payment to be made for these procedures, medical codes must be assigned. The primary illness of the patient is given a diagnosis code, and then each procedure performed by the doctor gets a procedure code.
The medical billing process??™s fifth step is the review of coding compliance, which means that actions satisfy the official requirements. Reviewing coding compliance means that employees follow guidelines in the assignment of codes. These codes must be checked for errors so that the payer is able to understand why the charges are medically necessary. Medical Billing Process Essay
Checking billing compliance is the sixth step. Not every code is billable??”the payer??™s rules determine whether a code is billable. If the rules are followed when preparing claims, billing compliance results. Specialists in medical billing have to use their knowledge of payer guidelines for determining whether codes are billable or not.
The preparation and transmittal of claims occurs next. Preparation of health care claims must be timely and accurate. The claim relays information to the payer about diagnoses, procedures, and chargers. The claim can report a visit to an HMO or it can ask for reimbursement for services rendered.
Next is monitoring payer adjudication. After the health plans have received health care claims, payment should be collected as soon as feasible because the medical practice needs the money from the plans in order to run their business. The word ???adjudication??? means that the claim passes through a series of steps that the payer has designed in order to determine whether a claim should be paid.
Generating patient statements is the ninth step in the process. After the payer has made the payment requested, the amount is applied to the patient??™s account with the provider. Usually the payments received by the provider do not settle the bill; the patient is billed for the remainder outstanding. Medical Billing Process Essay When a patient receives a bill from the provider, the dates and services provided are listed, as well as the payments made by the insurance and the remaining balance.
The final step is following up on payments made by patients, and if payments are not made, handling collections. All patient accounts are reviewed for bills that are overdue. If a bill is past due, the collection process begins. Financial records and patients??™ medical records are filed and kept according to the policy of the practice.