Breaking Down the Medical Billing Process

Breaking down the Medical Billing Process

Medical billing & collections can be a complicated and difficult process without proper organization. However, if the medical billing process is broken down into the following steps, it becomes a lot more easier to understand.

1. Registering patients – New patients must provide their personal information and insurance information to ensure that they’re eligible to receive medical services from the provider.
2. Confirming financial responsibility – Once the patient has provided their insurance information, the provider can determine what services are covered by their insurance plan. If the patient’s insurance won’t cover the service, they must be informed that they will be responsible for the entire bill.
3. Translating the medical report – Once a patient checks out, a medical report will be filed and translated to medical code that includes all pertinent information about the service provided, from the patient’s name and the treating doctor to the services provided. The report is known as a “super bill.”
4. Preparing the claim and checking compliance – The medical coder will give the super bill to the medical biller. It will then be put into a claim form, which will include the cost of the procedures. Once the claim is created, the biller must ensure that it meets the standards of coding and formatting compliance as well as standards of billing compliance.
5. Transmitting the claims – All claims must be submitted electronically according to the Health Insurance Portability and Accountability Act (HIPAA) of 1996. However, this only applies to standard transactions listed under the guidelines of HIPAA. Billers can still use manual claims, but this can result in low efficiency and a high rate of errors.
6. Monitoring adjudication – After the claim has reached the payer, the claim will undergo the adjudication process in which the payer evaluates the claim to determine whether it’s valid and compliant and how much of the claim will be reimbursed. Once adjudication is finished, the report will be sent to the biller. The biller will then have to check the report to make sure the codes match the initial claim.
7. Generating patient statements – Once the report has been received, a bill will need to be sent to the patient.
8. Following up on payments – The final steps is to collect payment on the bill. The biller must ensure the bill is set out on time and follow up on delinquent payments.

It’s important to consider that each provider has it’s own guidelines, notifications, processes and timelines processes and timelines for billing and collections. For more information about ProMD’s Management Billing & Collection services, please contact us now to schedule a free consultation.

ProMD Medical Billing is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 866-960-9558 or fill out our online form to request a billing assessment.

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