Step-by-Step Guide to the Process of Medical Billing Services
If you’re in the healthcare industry, medical billing is the term you would be familiar with. As a physician, you don’t need to go into details as you can outsource the medical billing services process to experts. But, for your information or that of beginner billers interested in the field, this step-by-step guide will make things comprehensive.
Let’s get into this.
What Is Medical Billing?
It’s a process where the insurance company pays on the patient’s behalf to ensure that healthcare providers get their reimbursement on time for their rendered services. However, the process is a bit complicated because several procedures are involved as aligned with HIPAA compliance rules.
Here is an overview of the process:
Patient Registration
The process begins when a patient schedules an appointment by contacting the front-desk staff or the medical billing company and the patient provides personal and insurance information to get an appointment and register for hassle-free treatment.
Insurance Verification
To ensure the patient’s financial liability and to prevent future inconvenience, the healthcare professional contacts the insurance company to confirm the patient’s insurance coverage. Consequently, the patient gets medical care on the schedule and the doctors get reimbursed as well.
Now, medical practices who have professional medical billing services at their disposal hand over this task to them.
Healthcare Delivery to Patients
The healthcare professionals provide the necessary medical assistance about diagnosis and prescribing medicines/procedures to the patient on the scheduled appointment.
The doctor keeps detailed records of the diagnosis and procedures along with the advice suggested by the practitioner. They also carefully keep the records documented as notes for the medical billing services provider.
Medical Coding
After the patient scheduled check-up, the outsourcing medical billing companies translate the healthcare provider’s documented paperwork into standardized codes for further processing.
The two main coding systems used by coders are:
- ICD (International Classification of Diseases) codes for diagnoses
- CPT (Current Procedural Terminologies) codes for procedures and services
Charge Entry
Once the procedures are technically coded, the biller receives codes and charges for the services provided by the practitioner to create a claim for reimbursement.
Claims Submission
The patient’s insurance company receives the claim from the medical billing services which includes the basic information about the patient, the provider’s detailed information, codes for the services provided, and the charges. Such claims are generally submitted digitally as per the compliance of HIPAA regulations.
Generation of EOB (Explanation of Benefits)
After reviewing the claim, the insurance company verifies it. They, then evaluate the claim and decide how much they will reimburse the healthcare provider via a statement called EOB.
These statements uncover how much the patient’s insurance covers for the rendered services.
Payment Posting
Once the insurance company processes the claim, they issue payment to the healthcare provider. The payment information is posted to the provider’s billing system, and any discrepancies are noted. These vulnerabilities can also lead to denied claims that medical billing services companies have to look into.
Follow-Up and Collections
The medical billing service team follows up on unpaid claims and patient balances. This may involve correcting errors, resubmitting claims, and contacting patients for co-payments.
Performance Analysis & Reporting to Clinicians
In order to track finances and the billing process, the billing team generates reports regularly to keep on accounts receivables and revenue cycle management.
These reports are insights into what the outsourcing company has been doing for the medical practice. Also, it displays a data-driven performance analysis to capture cash flow trends.
Conclusion
An effective medical billing services system requires knowledge of coding systems, an understanding of insurance processes, and HIPAA regulations to minimize errors and ensure timely payments. The process is detailed as mentioned and a lot goes behind the scenes. Thus, only experienced outsourcing medical billing companies should be reached out to if multiplying cash flow is the purpose.
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