Free Essay

Steps in the Medical Billing Process

In: Other Topics

Submitted By stcydksn
Words 602
Pages 3
Steps in the Medical Billing Process

Stacy Dickson

HCR/220

March 20, 2011
Alexander Mejia

Steps in the Medical Billing Process

The medical billing process is one that requires attention to detail to ensure that all the proper paperwork is completed properly and accurately. This process will begin form the time the patient enters to register for their appointment until after they have finished their appointment. This paper will provide the step by step process. Visit Step 1 Preregister Patients As part of the medical billing process, preregistering patients is required. This could be scheduling a patient for an appointment or it could be to update a patients appointments. This also allows insurance information to be updated in the patient’s files and to retrieve any demographic information. The medical scheduler will also inquire for the reason of the visit so that the appropriate amount of time is allotted for the visit. Step 2 Evaluate Financial Responsibility Evaluating the financial responsibility of the visit is extremely important, to ensure that the patients insurance covers and what the patients is responsible for. It is also establish if any prior authorizations are required before services are performed. Step 3 Check In Patients When a patient new patient arrives it is necessary to take a copy of their insurance card, drivers’ license, and have them complete a new patient form with their medical history, home address and emergency contact information. When an established patient checks in it is necessary to review their information and adjust any changes.

Step 4 Check Out Patients When a patient checks out after visit the medical codes for the services provided must be recorded. This way the medical coders can bill the insurance company for payment. Medical codes are given for each service provided; this makes the billing process easier and more organized. Claim Step 5 Review Coding Compliance The purpose of this step is to ensure that they codes are being applied correctly to the procedures and all the guidelines are being followed. If these procedures are followed properly the doctor’s notes and diagnoses should match up with the codes of procedures performed. Step 6 Check Billing Compliance As part of the billing process the importance of following procedures and guidelines is required. The purpose for this is to maintain compliance and to follow fee schedules and codes for payment on all health care claims. Step 7 Prepare and Transmit Claims Preparing and transmitting claims needs to be completed in a timely manner and needs to be completed correctly. In most healthcare facilities the claims department will complete these transmittals for the patient. Post-Claim Step 8 Monitor Payer Adjudication After health claims are sent in to the insurance companies, the collection of payments is important, without these payments healthcare facilities could not operate. The payments will vary based on the patient’s healthcare plan and any secondary plans, claims specialist will resolve any discrepancies. Step 9 Generate Patients Statements Once the patients insurance has paid all that is covered a statement is issued to the patient, reflecting what has been applied to the total amount and the remaining balance if any that the patient is required to pay. Step 10 Follow Up Patient Payments and Handle Collections A patient is responsible for all medical bills they incur that are not covered by their healthcare plan. If a patient is passed due on their bill it will then go into a collection process, and can incur interest and can affect the patient’s credit.

References
Axia College. (2008). Medical insurance: An integrated claims process approach. Retrieved from Axia College, HCR/220 website

Similar Documents

Premium Essay

Steps in the Medical Billing Process

...Steps in the Medical Billing Process Annette Callen 02/11/2012 I am writing this paper to discuss the ten steps of medical billing. The ten step process consist of patient preregister, establish financial responsibility for visits, check in patients, check out patients, review coding compliance, check billing compliance, prepare and transmit claims, monitor payer adjudication, generate patient statements and follow up patient payments and handle collections. These steps are under three categories these categories are visit, claim and post-claim; throughout this paper I will explain each of these ten steps. The first category is visit; step one of visit is preregister patients. This step usually involves the clerks at the front desk or nurses depending on the size and location of the health center. The clerks are responsible for checking in patients, scheduling appointments and making appointment reminder calls. The clerks are also responsible for collecting the patient personal and payer information. Step two is establishing financial responsibility for the health visit. This step is where the clerks will collect the payer insurance information, set up a payment plan, and let the nurses and doctors know what is covered by the insurance company such as treatments, testing and medications....

Words: 974 - Pages: 4

Premium Essay

Steps in Medical Billing Process

...Steps in the medical billing process The following ten steps will show you the order in which to do the medical billing process: I. Pre-Register patients: patient’s appointments are needed to be scheduled and kept updated. Basic insurance information should be added to the patient’s record, as well as their personal information: age, gender, weight, and height. To make sure no appointments get missed a reminder call should be made. When the patient makes their appointment, ask for an insurance card, copy it front and back then add to the patient’s medical record. II. Establish financial responsibilities for visits: As the patient shows they have insurance: their health plan coverage needs to be reviewed and its eligibility needs to be verified. It is recommended to be sure to ask the patient whether or not if there is more than one insurance company. If this is true, then the first payer should be decided. Once verified and checked that all provisions have been met, steps need to be followed to acknowledge payment for services. III. Check in patients: A new patient who is new to the practice; complete personal and medical information is collected. If the patient is returning their information needs to be reviewed, updated and verified if needed. Insurance cards and identification cards should be copied front and back, and placed in their medical chart. Any office visits that are co-payment dues should be collected at time of service. IV....

Words: 722 - Pages: 3

Free Essay

Ten Billing Steps

...Donna Purvis, MBA HLTH245 Principles of Reimbursement Management September 29, 2015 Ten Step Billing Process The ten steps of the medical billing process have been divided into three categories: The visit, the claim and the post claim. Following the billing steps to complete correct claims ensures that providers are paid accurately and timely for services and procedures. The Billing process begins with the preregistration of patients. Collecting personal, basic demographic information, and insurance information and entering that information into the database. All of this personal information can be referred to at any time during the medical billing process. Keeping up to date patient and insurance information makes patient check in more efficient and eliminated potential billing errors. Confirming financial responsibility is the next step in the billing process. Once a patient’s information has been updated in the computer system it is then the medical staffs’ responsibility to determine who will be paying for the services rendered for the appointment. Insurance providers are contacted and benefits are verified as different plans have different levels of coverage. Once the medical staff is aware of what the allowable insurance benefits are, contact with the patient should be made so the patient is aware of their responsibility for out of pocket, non-covered expenses, co-payments, and deductibles....

Words: 1284 - Pages: 6

Premium Essay

Billing Process

...The medical billing process is a process in which by medical billing specialist to provide maximum, payments for medical services that are provided. The medical billing process contains ten steps and these steps are made up of three categories: The visit, the claim, and post claim. During the visit steps one through four occurs. Pre-registering the patient is the first step. This where an appointment is scheduled and updates are made to pre-register the patient. Collection of all information such as, insurance and demographics on the patient is collected during this visit. Reason for the visit is provided at this time. Determining the patient’s financial responsibility is the second step. If the patient has insurance coverage verification of patients eligibility must be made .The patient is responsible to pay whatever percent of the bill that the insurance does not cover and if no insurance is provided the patient is responsible for the cost of all services that have been provided. The third step of the process is checking the patient in. New patients are required to provide medical insurance if available and medical information is collected for the patients’ file. If patient is a returning patient then information is verified and if any information is incorrect or has changed then it is then updated. Photocopies of Drivers licenses and insurance cards are taken and filed in the patients’ record....

Words: 659 - Pages: 3

Premium Essay

Medical

...Medical Billing Process There are several different steps in the medical billing process that have to be followed. Each step is very unique and should be followed accordingly. The first step in the medical billing process is to pre-register all patients. This process requires you to schedule patients for new treatment. You are also required to update appointments for new and old patients. Upon preregistration it is also your job to collect both demographic and all of the patients insurance information. Patients have to provide their reason for the desired appointment so that proper treatment can be scheduled and provided. The next step in the medical billing process is to establish financial responsibility. During this process, determining if an insured patient has enough coverage for the type of visit is determined. Patients will be asked a series of questions about the type of insurance they have and the healthcare facility will of course run the insurance to see if it will pay for the visit and the service. If certain services are not covered by the patients insurance, then the patient will be informed and further actions will be taken. It is very important that the financial information is taken upfront. I say this because patients who do not have the appropriate health insurance will be treated and in the end cannot pay, causing the healthcare facility to lose money. The third step in the medical billing process is to check in patients....

Words: 935 - Pages: 4

Premium Essay

Medical Billing and Reimbursement

...There are seemingly simple steps to preparing a claim. “These steps include: Registration, establishment of financial responsibility for the visit, patient check-in and check-out, checking for coding and billing compliance, preparing and transmitting claims, monitoring payer adjudication, generating patient statements or bills, and assigning payments and arranging collections.” (“medical billing process”,...

Words: 1059 - Pages: 5

Free Essay

Medical Billing Process

...Medical billing is a process that doctors and insurance companies use. Doctors use the process to submit claims to insurance companies so they can be paid for their serves rendered. The billing process consists of 10 steps. These steps have been broken down into three different categories. The visit, the claim, and the post claim. The first category consists of the first four steps. The first step in this category is “The Visit”. During this step the patient is pre-registered. A returning patient or a new patient is pre-registered by making appointments for a future visit or an appointment to start serves. Each patient upon their visit is as asked for their insurance information and demographic information. Returning patients and new patients are to provide the facility with the medical purpose of the visit. Step two is to determine what the patient’s financial responsibility will be. The patients insurance usually has a set payment, which is usually 80/20. The insurance will pay 80% of the bill and the patient is responsible for 20% of the bill. For patients that are uninsured, the patient is responsible for all of the medical charges. Step three, the patient actually gets check-in. Returning patients are asked if all information is still the same as the last visit. Which includes insurance, address, phone number, ect. New patients are asked for all medical and insurance information....

Words: 722 - Pages: 3

Free Essay

Medical Billing

...Medical Billing Process Nathia Herod HCR/220 2/26/2012 Melinda Sousa Medical Billing Process There comes the time in everyone’s life that just about almost everyone who is adults has gone through some part of the medical billing process. It is a process in what keeps most workers in the field their job and some patients their health. In the end, in order for everyone to be satisfied, everyone must play their role and work together. In order for the patient to understand what they are paying for; the biller must know who to bill and what they are paying for as well. There are ten steps of the medical billing process and the first step of this process would be to always pre-register the patients. When you break this step down a little further all it means is that you are setting appointments for the patient but first thing’s first, you must get their insurance in order to know what the patient is going to pay and what they are not going to pay. When the patient is done being preregistered; you are now available to state their financial responsibility for the visit. Most of the time when patients are preregistered, they kind of already have a prejudgment as to what they are going to pay because of their insurance which also establishes a financial responsibility. You must clarify clearly in the beginning as to why they are paying for this and not paying for something else....

Words: 817 - Pages: 4

Free Essay

Accurate Registration Worksheet

...Some providers will receive a copy of the check in. 4 Check out Patient- When the patient is checked out, the medical report from that patient’s visit is sent to the medical coder, who will decode and translate the information into a report. This report, which also includes...

Words: 1178 - Pages: 5

Free Essay

Evaluating Compliance

...Evaluating Compliance Strategies HCR/220 Compliant billing involves certain steps in order to properly bill a patient and receive any monies owed for those services performed. First step is for the doctor to fill out and sign any and all forms at the end of a patient’s visit. The next step is to post the transactions made along with the proper medical codes from a patient’s appointment into the practice management program which leads to the claims being filed. Payers then need to make sure that the services performed along with the diagnosis must show that it was medically necessary services. The billers also need to know the proper rules and guidelines put forth by a patient’s insurance company. Because medical insurance companies constantly change their policies, the insurance specialist rely on the payer’s website or may regular communicate with a representative of the payer. The correct coding initiative controls improper coding that would result in improper payments for Medicare claims. The CCI also monitors billing of any services that Medicare believes cannot be performed together. The CCI also requires doctors to tell about the most extensive service that was performed and not the revealing of both the extensive and limited services. Finally the CCI also tests for unbundling. Many mistakes can be made while billing/coding a patient....

Words: 816 - Pages: 4

Premium Essay

Evaluating Compliance Strategies

...Some compliance errors can be a result of incorrect code selections or billing practices, while other errors are related to medical necessity. Errors also result in non-payment of services performed on patient. Some errors in the coding process would be; truncated coding- using diagnosis cods are not as specific as possible, mismatching between gender or age of...

Words: 682 - Pages: 3

Premium Essay

Free

...new74598_ch01_001-024.indd Page 1 24/09/12 1:18 PM user-f502 /202/MH01799/new74598_disk1of1/0073374598/new74598_pagefiles FROM PATIENT TO PAYMENT: UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement....

Words: 12818 - Pages: 52

Premium Essay

Medical Billing Process

...Medical Billing Process HCA 220 11-03-13 Axia University of Phoenix Medical Billing Process When you go to the health care provider’s office for care, the admitting or office registration department gathers information about you the person responsible for paying for the services and the insurance that will be billed. Step 1: Pre register Patients. By scheduling and updating appointments get the patients demographic and insurance information. Step 2: Establish Financial Responsibility for their visits – verify insurance eligibility and figure out how much to collect from the patient. You get this info by figuring what services are covered by the plan and what services are not covered, and if there are any billing rules to the plan. Step 3: Check in Patients have them sign in then collect whatever necessary money from them, and copy or scan their current insurance card. When this is a new patient they collect detailed and complete demographic and medical information. A regular patient would need to verify their demographic and medical information is correct. Step 4: Review Coding Compliance. Compliance means actions that satisfy official requirements, with coding compliance means following official guidelines when codes are assigned. Obtain CPT and ICD-9 from the doctor(s) next verifies all information is correct before entering it into the computer system. Step 5: Review Billing Compliance....

Words: 512 - Pages: 3

Premium Essay

Hcr 220 Week 7

...Running head: Evaluating Compliance Strategies Assignment: Evaluating Compliance Strategies Name Axia College of University of Phoenix HCR 220 Date “Guidelines established by the healthcare staff and laws established by HIPAA are what make up the compliance process. These laws and guidelines were established to protect the patients, physicians, and staff members” (U.S. Dept. of Health and Human Services, n.d.). Errors in the office can be avoided by having a compliance process in effect. Using updated billing and coding software will help reduce errors made in the billing process. I agree with having a guide consisting of codes to aid in the billing process. I do regard this as cheating rather, to be used as a guide. Many offices currently have sheets that are located on the front of the patients’ file with the diagnosis and the code next to the diagnosis which the physician fills out. This eliminates an unnecessary step in the billing process and is a quicker, easier, and more accurate way to avoid errors. “In order to avoid rejection of the claim, it is important that the diagnoses and procedures are correctly linked” (AAFP, 1999). This also ensures that the claim is paid for the correct procedure performed by the physician. If an incorrect procedure was billed this could result in a loss of money by the physician for the type of procedure that was performed....

Words: 911 - Pages: 4

Premium Essay

Medical Billing Worksheet

...University of Phoenix Material Steps in the Medical Billing Process Part A Reference: Ch. 1 of Medical Insurance Complete the following table by identifying the 10 steps in the Medical Billing Process. Write 2 to 3 sentences describing each step. Be as specific as possible. For example, Step 1 may be, “Preregister Patients.” |Step |Description | |Step 1: Preregister patients |The patient schedules and appointment to see the doctor. The doctor’s office collects | | |preregistration demographics and insurance information. Appointments are updated if | | |needed. | |Step 2: Establish financial responsibility |Once the appointment is made now you have to see what is covered under the patient’s | | |insurance plan. What is not covered? You also need to find out the billing rules of the | | |patients insurance. | |Step 3: Check in patients |When the patient arrives for their appointment they are to sign in....

Words: 720 - Pages: 3