Steps in the Medical Billing Process
October 20, 2013
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 of the patient or payer, is very important. An insurance specialist must know what the payer will cover for the patient and what the patient must pay. This way they can make the patient aware of what services they must pay for out-of-pocket. The insurance specialist must also determine who the first payer is, that is if a patient as more than one health plan. So that they can follow the payers rules for any preauthorization’s or services.
Step: 3 Check in Patients
When checking patients all information is verified including personal, patients are given patient rights forms, insurance cards are copied and kept in the patient record. All this information is collected to verify coverage and to make sure the patient has no outstanding bills. The insurance specialist must keep all the patient information up to date.
Step 4: Review Coding Compliance
The insurance specialist must comply with coding guidelines. To do this the insurance specialist will make sure that all codes for diagnoses and procedures are correct. They can verify this information by consulting the patient record. In some facilities the physician will apply the codes, but most have an insurance specialist. Once the codes are verified an...