In the health care sector, something you might be more familiar with is called Medical Billing. Well as a physician, you may not want to go into details at the moment because you can always outsource the medical billing services process to other professionals. For the record or for your or for any new enthusiast in the field of biller, this step by step guide will ensure that things are made easier.
What Is Medical Billing?
It is a system whereby the insurance firm provides the money to the patient intending to recover the amount from the health care provider in anticipation. But it is a little complicated since several steps are followed along with the HIPAA compliance rules.
Patient Onboarding
The process starts when the patients call the front-desk staff or the medical billing company to make an appointment and the patients submits his or her and insurance number to obtain the appointment and to enroll for the services without many complications.
Insurance Verification
For the patient’s own good and for future inconveniences, the healthcare professional dials the insurance company to confirm the insurance coverage brought by the patient. In this regard, the patient gets his/her treatment on time while the doctors are also paid on the same receipt. Today, the professional medical billing services are available to the medical practices and thus they delegate this duty to them.
Delivery of Healthcare to Patients
The healthcare professionals deliver the relevant healthcare regarding the diagnosis and recommending the drugs/treatments to the patient on the arranged session. In patient records there is diagnosis and documentation of the diagnosis, various processes and advice of the practitioner. They also make sure that they keep with them the records that are taken in note from to present to the medical billing service provider.
Medical Coding
When the patient had made the scheduled check-up, the outsourcing medical billing companies’ interpret the documented paperwork written by the healthcare provider into standard codes for subsequent processing. The two main coding systems used by coders are:
Convert Diagnoses to ICD-10 Codes
Using the International Classification of Diseases, Tenth Revision (ICD-10) codes, we accurately represent the patient’s diagnoses. Proper coding is essential for compliance and ensuring appropriate reimbursement.
Assign Services Using CPT Codes
Next, we apply Current Procedural Terminology (CPT) codes to describe the services provided. Assigning the correct CPT codes is essential for ensuring that the billing reflects the actual services rendered.
Charge Entry
After the procedures are technologically coded, codes and charges for the services that the practitioner offered are given to the biller to formulate a claim for reimbursement.
Claim Preparation
The insurance company that the patient is enrolled with incurs the claim from the medical billing services and it has basic information about the patient, detailed information about the provider, codes for services offered and the charges. Such claims are most often completed electronically according the rules of the Health Insurance Portability and Accountability Act (HIPAA).
Claim Submission
The prepared claim is submitted to the insurance company, either electronically or via paper, depending on your practice’s preferences and the insurance company’s requirements.
Insurance Response (EOB Generation)
After the insurance claim is investigated, the insurance company affirms it. They, next evaluate the claim and set how much they will compensate the healthcare provider through EOB. These statements show just how much the insurance of the patient contributes to the rendered services.
Recording Payments
After the insurance company has reviewed the claim they will then send the money to the healthcare provider. The payment information required is sent to the provider’s billing system and abnormality is highlighted. These vulnerabilities can also cause denied claims that medical billing services companies have to consider.
Follow-Up on Outstanding Balances
The medical billing service team deals with claims that remain unpaid and patient outstanding balances. This can include error corrections, claims resubmission and follow up of people with regard to co-payment.
Financial Reporting and Analysis
For account tracking and billing process in the organization, the billing team prepares reports for accounts receivables and revenue cycle management analysis regularly. These reports are experience into what the outsourced company has been doing for the medical practice. Also, it presents a data-oriented performance analysis to capture and demonstrate the cash flow picture.
Patient Billing
After insurance payments are processed, any remaining balances are billed to the patient. Clear communication about outstanding balances fosters transparency and trust, helping to maintain positive relationships with your patients.
Handling Claim Denials
Claims may be denied for various reasons, including incorrect coding or eligibility issues. Effectively managing these denials involves reviewing the reasons, making necessary corrections, and resubmitting claims promptly to ensure that your practice is compensated.