Jan 28, 2023

8 Basics Steps of Successful Medical Billing Process

  • By Eva Johnson,

Medical billing is a long and complicated process, similar to medical coding. However, with an appropriate billing plan, your medical practice can run smoothly without any hassles. Just in case, if you are not sure about how to draft this plan, here are a few critical steps of a successful medical billing process.

1. Patient Check-in

Patients are asked to complete the forms, and confirm their information on file (if it’s not a first-time visit) upon their arrival. Along with the form fill-up, patients should also provide some official identification, such as passport, driver’s license, in addition to their insurance card.

2. Verify Insurance Information

Before every appointment, patients have to verify their insurance information and their eligibility to claim it. Insurance information keeps changing at times, impacting the benefit and authorization details. Therefore, it’s essential for healthcare facilities to ask patients about those changes before every visit.

3. Medical Coding

In this step, medical coding fixes the diagnosis and the procedure codes for patients based on some standards, such as CPT and ICD-10. The five-digit procedure code indicates the service used, and the diagnosis code determines the doctor’s medical diagnoses.

4. Charge Creation

After verifying all the documents and completing the coding process, the billers create medical claims (within 24 hours), which follows the rules referring to a specific location and carrier. The charge creation also consists of the linking of medical codes to specific procedures and services used during the patient’s visit.

5. Claims Audit

The patient’s medical claim will undergo an auditing session consisting of extensive checking at several levels. The completed claims will be rechecked for correct procedures and diagnosis codes, and valid and complete data. In most cases, the applications are rejected because of incomplete or incorrect details.

6. Claims Transmission

The audited medical claims of patients are filed and sent across for a final follow-up check. It is done before sharing the claims with the claims transmission department along with the required patient details and the verified documentation.

7. Claims Submission

The final version of the recorded medical claims will be sent to the respective insurance agencies and government departments in a printed format. In this step, claims are sent along with the related patient information and the necessary documents for the ultimate settlement.

8. Follow-Up and Clearance

In the final stage, the billers are in charge of sending out correct medical bills and then following up with all the patients whose bills are delinquent. If the bills are paid, the information will be stored with a respective patient’s file. If not, the biller has to follow up until the provider is paid adequately for their services. Following the above steps will undoubtedly smoothen the experience in the medical billing process and minimizes the everyday hassles encountered by hospitals and healthcare facilities.

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