The medical billing process is used by healthcare providers and insurance companies to submit and follow up on medical services in order to receive payment. There are ten steps to the medical billing process. These steps are made up of three categories: The visit, the claim, and post claim.
Steps one through four occur during the first visit to the healthcare provider. Step on is pre-registering the patient. A schedule or an appointment update needs to be made to pre-register the patient. Insurance information and demographics on patient must be collected during this visit. A medical reason must be provided for the visit.
Determining the patient’s financial responsibility is the second step. To be eligible for insurance coverage doctor’s office standards must be met by the insurance provider. Patients are responsible to pay whatever percent of the bill that the insurance does not cover. If the patient does not have insurance, the patient is responsible to pay the whole bill.
Checking the patient in is the third step. If the patient is new all insurance and medical information is collected. Returning patients have to verify and change information if any information is wrong or has changed. Photocopies of Drivers licenses and insurance cards are taken a filed for future use. Patient must fill out medical forms before being seen by the doctor. Co-payments are paid before or after the visit depending on doctor office policy.
The Check-out procedure is the fourth step. For billing purposes, all visits, diagnoses, and treatments are documented and coded. Medical insurance specialists use the medical codes for procedures and diagnoses to update patient files and submit claims to the insurance companies.
Category two of the billing process is the claims category. Steps five through seven are included in this category. Reviewing the coding compliance is step five. There are official guidelines that must be followed by medical codes to satisfy insurance...
References: The McGraw-Hill Companies (2008) Retrieved November 18, 2010 from Medical Insurance: An Integrated Claims Process Approach, 3rd addition, Chapter one
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