Hcr 220: Steps In The Medical Billing Process

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Steps in the Medical Billing Process Donna Kimble HCR/220 October 20, 2013 Harry Holt Step1: Preregister Patients All patients appointments are scheduled, confirmed and updated each day. When new patients call into the physician’s office they are asked for basic personal information and their insurance. These questions are asked to verify if the patients insurance is accepted by the provider, and to find out if the services the patient is seeking to have are covered by their plan. All patients new and returning are asked about the reason for visits, if any personal and insurance information has changed, and are also given their privacy and rights forms. Step2: Establish Financial Responsibility Knowing the financial responsibility…show more content…
Example: Previous balance + Charge –Payment = Current Balance. Step 5: Review Billing Compliance The insurance specialist will check the provider’s practices fee schedule for codes to determine appropriate billing. They must check this schedule because not all codes are billable. This will depend on the payers coverage rules. Step 6: Check Out Patient Patients are checked out through three is steps. First all noncovered services, any charges of nonparticipating providers, deductibles, and any charges for self-pay patients are made clear to the patient. All payments and copayments are then collected from the patient. Finally all receipts are given to the patient and any further appointments are scheduled. Step 7: Prepare and Transmit Claims An insurance specialist we gather all information about services and charges. He/she will then use the PMP to prepare the claims which will then be forwarded the payer. The claim will contain all services, diagnoses, procedures, and any further treatment to be done. Claims maybe for reimbursements or to report being seen by an HMO. Every facility will have a schedule for filing claims, they can be daily or every other day. This schedule is maintained. Step 8: Monitor Payer…show more content…
The insurance specialist must stay on top of payers, whether it be a health plan or patient. These payments go straight into accounts receivable for the practice. To do this the insurance specialist goes through a process called adjudication. This process determines whether the claim will be paid, or wait on further information from the provider. Step 9: Generate Patient Statements This step provides the patient with an account of their visit. It will show all services, dates, and procedures received. Plus what the payer has paid and any balances due. Step 10: Follow Up Payments and

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