There are many necessary and very important steps involved in the medical billing process. These steps include: preregistering patients, establishing the financial responsibility for the patients visit, signing the patient in, checking the patient out, reviewing coding compliance, check billing compliance, preparing and transmitting claims, monitoring payer adjudication, generate and provide statements for the patient, and following up on patient payments and handling any collections (Valerius, Bayes, Newby, & Seggern, 2008). The first step in the medical billing process is preregistering the patient.
The two main tasks of this step in the process is to schedule and update appointments, and to collect all the patients basic information; including the reason they need to be seen. If this information is not collected or is given incorrectly the whole medical billing process is put on hold (Valerius, Bayes, Newby, & Seggern, 2008). The second step of the medical billing process is to establish financial responsibility for the visit. During this step the financial responsibility is determined by the information that has been received.
Patients who have medical insurance coverage are required to answer several questions about their specific healthcare coverage. Once all the information has been received the information must be verified (Valerius, Bayes, Newby, & Seggern, 2008). The third step of the process is to check the patient in; which is different depending on whether the patient is a returning patient or a new patient. Returning patients are asked to review, verify, and make any necessary changes to their records, and new patients are asked to fill out forms and give complete demographic and medical insurance information.
Financial records are also checked to make sure that payments are up-to-date. Payments and copayments are also determined and noted during this step (Valerius, Bayes, Newby, & Seggern, 2008). The fourth step is to check patients out, and record the medical codes. In order for the billing process to occur, the medical procedures that have been provided and the diagnosis must receive medical codes and the codes then need to be verified with the data in the patients medical record. Transactions for the visit are entered into the patient ledger and the patients balance is updated (Valerius, Bayes, Newby, & Seggern, 2008).
The fifth step is to review coding compliances; which is to satisfy official requirements. Once the codes for the diagnosis and the procedures have been assigned, they must be reviewed and checked for any errors. It is important that the medical services and the diagnosis that have been documented in the patients file are related so that there is no confusion for the payer, so that they can understand the claim that has been processed (Valerius, Bayes, Newby, & Seggern, 2008). The sixth step is to check the billing compliances.
All charges and fees for the visit are related to specific procedure codes and not all codes are considered billable. Determining whether or not the codes are covered is done by the payer (Valerius, Bayes, Newby, & Seggern, 2008). The seventh step is to prepare and transmit claims; which is to prepare the claim accurately and submit the claims for payment. The claim my not be submitted right away because this process depends on the billing schedule of the service provider (Valerius, Bayes, Newby, & Seggern, 2008). The eighth step in the medical process is to monitor payer adjudication.
During this process payments for services are collected from the insurance plans and from the patients. It is important that the payments are received so that the practice can continue to operate. Adjudication occurs when the payer reviews the claim to determine if the claim will be paid and how much of the claim will be paid. The amount that is covered by the payer depends on the contract between the payer and the provider. An appeal may also be started at this time if there are any discrepancies found during this time (Valerius, Bayes, Newby, & Seggern, 2008).
The ninth step of the process is to generate patient statements. During this process the payments from the payer are applied to the patients account and any remaining balances are charged to patient and a statement is sent to the patient to inform them that payment is due (Valerius, Bayes, Newby, & Seggern, 2008). The final step in the process is to follow up patients payments and handle collections. During this process payments are reviewed to check to see if they are up-to-date or if any of the balance is past due; if there is a past due balance the collection process is started (Valerius, Bayes, Newby, & Seggern, 2008).