8 keys steps involved in the medical billing process

Medical billing is often a complicated process. People involved in formulating medical bills are often asked to take certification exams such as CPB exam, CMRS exam, and RHIA exam. Training in medical coding, audition, and transcription can be also useful. A bachelor’s or graduate degree in medical information science and technology is often a prerequisite qualification for medical billers. However, these certifications and qualifications have not been made mandatory by law.

The process of medical billing is required for receiving payments for services such as treatments, testing, and procedures. Adopted by insurance companies and healthcare institutions to settle medical treatment and services bills, the medical bill process has three broad stages—check-in, claim and post claim. When the medical billing process runs smoothly, a claim filed by a patient will go through each of these stages once. Ideally, in such cases, the process is hassle-free without any roadblocks. This makes the claim reimbursement quicker.

However, the medical billing process can be quite tedious. This is due to the inclusion of multiple authentications and verifications required to prevent fraudulent activities. Here are the 9 key steps involved in the medical billing process.

  • Patient registration
    Also known as patient check-in, this is the first step of the medical billing process. It includes all the patient information such as contact details, insurance card, information policy number, medical history, and medical reports. It also includes all the patient’s demographic information. All the information that will be required during claim submissions has to be taken in during patient check-in.
  • Insurance verification
    In this stage, the insurance information given during patient check-in is verified. The eligibility, coverage, conditions, and benefits of the insurance are double checked. Verification needs to be done during every patient visit. This is because insurance information can change at any time. Hence, it is important to ask a patient whether their insurance information has changed since their last visit. In case, there is a change, it can affect the benefit and authorization information. Hence, medical practitioners and insurance providers always double check insurance verification.
  • Medical coding
    This is one of the important steps in the medical billing process. The appropriate medical coding for claims is important because the code will inform the insurance payer the exact reason for the patient’s treatment. The medical code also indicates the method of treatment. It is important to ensure that the correct diagnosis codes are being used to describe a patient’s illnesses and symptoms. Also, ensure that the correct procedure codes are used to describe the patient’s treatment method. Additional CPT and HCPC codes modifiers can be used to provide more information about a service or procedure. CPT and HCPC are standardized coding systems developed by the American Medical Association and Centers for Medicare and Medicaid. Correct assessment can be made by an insurance payer only if the correct codes and modifiers are used.
  • Filing of charges
    This stage involves documenting all the charges of every medical procedure that a patient is undergoing. This will include a tabulation of all the charges and details of the diagnosis, procedures, and services given to the patient. While filing charges, ensure that the charge entry includes all the correct linking of medical codes to procedures and services given to the patient during their visit. In case, there has been an incident involved, such as a road accident, this needs to have a special mention. This is because it will have an impact on the benefits given by the insurance provider.
  • Auditing claims
    Once the claim has been filled, it needs to be audited. The document needs to be thoroughly checked to avoid any errors or omissions. This will help in easing the medical billing process. Also, this will avoid any delays in the process.
  • Submission of claims: After a claim has been correctly filled and completed, it is submitted to the insurance payer to who will initiate the payment. There are guidelines issued by insurance providers for medical billers regarding how and when to submit claims. Although most providers have a common set of guidelines, a few may follow different procedures for claim submission. It is essential that medical billers have all the necessary access to information about all insurance providers.
  • Follow-ups
    Once the claim has been submitted, medical billers will monitor these claims. They will have to initiate follow-ups with the insurance provider. Timely updates regarding the claims will be given to the billers.
  • Reimbursement initiation
    Once the payment has been made by the insurance provider, it needs to be reviewed. After the amount has been verified, the patient’s account will be updated. The patient will be notified, in case there is a balance amount required to be paid.

Although the process is complex, it helps to know the basic stages of medical billing. This will help to resolve any issues that may arise during claims reimbursement.

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