Steps in Medical Billing Process Medical billing is an integral part of the medical field.

Without it the medical facilities would not be paid for services rendered to its patients. The re are ten basic steps to follow when it comes to billing. These ten steps fall within three categories; which are visit, claim, and post-claim. The first category, visit, consists of four steps; preregister patients, establi sh financial responsibility for visits, check in patients, and check out patient s. The first step, preregistering patients allows the facility to schedule, canc el, or reschedule appointments for either new patients or returning patients. Th is step also includes obtaining information regarding insurance. Patients also p rovide the facility with the need for their visit. Step two, establishing financ ial responsibility for the visit, allows the facility to verify eligibility for the patient s health care plan and what the plan covers. It also allows the facility to determine the amount of the visit the patient is responsible for. Finally it allows the facility to meet any prerequisites for payment. The third step is ch ecking in patients. This includes the process of gathering and reviewing detaile d medical history. Vital documents and identification are filled out or scanned into the patient s records. At this point the facility will view the patient s records f or any outstanding payments and request copayments; however, this will vary depe nding on the facility s procedures. The fourth step, or final step in this category, is checking patients out. The physician s staff assigns the appropriate codes for t he visit. Patient records are also updated with the cost of the visit and any pa yments received. Usually any follow-up visits are also scheduled at this point a nd time. The second category, claims, consists of three steps. These steps are review cod ing compliance, check billing compliance, and prepare and transmit claims. Step five, reviewing the coding helps ensure that the facility has followed the offic ial rules and regulations. This also helps prevent any errors within the codes t hat have been assigned to any diagnostic tests and procedures performed. At this point one should also ensure that the medical information is properly linked, s o the health plan and/or payer are able to clearly understand the charges. The s ixth step, check billing compliance gives the facility a chance to ensure that t he billing has met the necessary guidelines to help prevent wrongful billing. Ea ch procedure and diagnostic test is assigned a code and fee. Not all codes are c overed under a patient s health care plan. If a certain code is not covered under th e health care plan it then becomes the responsibility of the patient. Step seven , the final step in the second category, is preparation and transmitting claims. The preparation of a claim is normally done by the physician s office on behalf of the patient. The claim is the communication between physician and health care pl an for payment on services rendered. After the claim has prepared it is then sen t to the insurance provider, typically electronically, for review and payment. The final three steps; monitor payer adjudication, generate patient statements, and follow up patient payments and handle collections are found under the final category, post-claim. The eight step; monitor payer adjudication is simply a ser ies of steps performed to determine whether or not a claim should be paid. This is also the point that the insurance company ensures that there are no discrepan cies found. Once the payer makes a decision regarding a claim they will issue a report to the physician with, or without, payment depending on the decision. Ste p nine, generate patient statements is done after payment has been received from the insurance company and credited to the patient s account. If there is an outstan ding balance a statement is generated. The statement being sent to the patient w ill include dates and the types of services performed along with any credits rec eived, leaving the balance due. The last and final step, step ten, is to follow up on patient payments and handle collections. If a patient takes longer than pe rmitted to pay an outstanding balance the physician s office will typically make a c all inquiring as to why payment has not been received. After multiple attempts o f trying to collect payment the account is typically handed to a collection agen cy for further attempts. There are also guidelines that dictate how long and wha t type of documents are allowed to be kept. The steps of medical billing are put in place to ensure the accuracy and timely

payments on claims. If the steps are followed carefully minimal, if any, errors should occur. The steps are also universal within the medical community to preve nt confusion when it comes to creating and processing claims.