Know the Steps of Medical Billing Process

The medical billing process is a succession of steps performed by billing specialists ensuring that medical professionals are repaid for their services.

Depending upon the conditions, it is a matter of days to complete or may stretch over several weeks or months.

While the process may vary slightly between medical offices, here is a broad outline of a medical billing workflow:

Patient Registration

In the case of medical billing, patient registration is the first step. This is the collection of basic demographic information on a patient, including name, birth date, and the reason for a visit together with the Insurance information.

Financial liability

The second step is to look over the patient’s financial responsibility to find out which procedures and services to render during the visit are covered. If there is any service that is not be covered by the medical billing process the patient is made aware that they will be financially responsible for those costs.

Superbill Creation

At the check-in time, the patient will be asked to complete forms for filing. In case it is a return visit, confirm or update the filed information.  Identification of the patient, together with valid insurance card co-payments will be collected.

Claims Generation

The medical biller will then use the superbill to prepare a medical claim to be submitted to the patient’s insurance company. Once the claim is generated the biller must examine it carefully to confirm that it is HIPPA compliance including the standards for the medical coding and format.

Claims Submission

The next step is the submission soon after the claim is checked. The exception to this rule concerning the high-volume payers, who accept claims directly from healthcare providers.

Monitor Claim Negotiation

In the medical billing process negotiation is the process by which payers estimate medical claims and determine whether they are valid and compliant, and if so, the provider will receive the reimbursement. The claim may be denied or accepted during this process. An accepted claim is paid according to the agreement of the insurer.  A rejected claim is corrected and resubmitted.

The preparation of the Patient Statement

After the claim is processed, the patient is billed for any unresolved charges. The statement generally includes a thorough list of the medical billing process and services provided, including the costs, the amount paid by insurance, and the amount unpaid by the end of the patient.

Finally, the medical billing process needs to be ensured that the bills are paid in the right way.  Medical billers must follow up with patients whose bills are delinquent, and, when necessary, send accounts for collection.