Steps in the Medical Billing Process

Topics: Health care, Health care provider, Illness Pages: 3 (729 words) Published: September 20, 2009
Medical billing is a process that health care providers and insurance companies use to submit and to follow up on medical services and treatments in order to receive payment. The ten steps of the medical billing process have been divided into three categories: The visit, the claim and the post claim.

The first category has steps one through four that occur during the initial visit. The first step is to pre-register the patient. To pre-register a new or returning patient, a schedule or an update for appointments need to be made. A patient’s demographic and insurance information needs to be collected. New and returning patients also need to provide a medical reason for the visit.

The second step is to determine the patient’s financial responsibility regarding the visit. The patient’s health plan and insurance must meet the doctor’s office standards regarding eligibility. Patients are responsible for all charges not covered by their health plan. Uninsured patients are fully responsible for all medical charges.

The third step is the actual check-in of the patient. For new patients, all medical and insurance information is collected. Returning patients have to review previously recorded medical information. Insurance cards and drivers licenses are photocopied and filed for future reference. Medical forms are to be filled out and co-payments are collected either before or after doctor visit.

The forth step is the check-out procedure of the patient. All patient visits, diagnoses and procedures are documented and assigned medical codes for billing purposes. The medical codes for diagnoses and procedures are used by medical insurance specialists to update the patients’ files and to submit claims to the medical insurance companies.

The second category of the medical billing process is known as the claim. It has steps five, six and seven. The fifth step is to review coding compliance. Medical codes have to follow official guidelines...

Bibliography: Valerius−Bayes−Newby−Seggern, (2008). Medical Insurance: An Integrated Claims Process Approach (3rd ed.). , : The McGraw-Hill Companies.
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