The process of Medical Billing started from the visits to office and continues with the billing and collection processes.
Medical billing is about to claim of receiving payments with health insurance companies for the services providing by the health care organizations, clinics and hospitals. It does not matter if the companies are government sponsored or by the private sector, the process remains same with all. The patient is the main object of this whole procedure.
It is the process which is consisting of following some steps which makes this service easy and accessible.
1. Insurance verification: Insurance verification services or insurance authorization plays very important role in generating the process. It involves the insurance details of patients and finding declaration through the online verification.
2. Entry of patient demographics The demographics of patients includes; full name of patient, gender, age, date of birth, address, contact details, patient’s ID and other related information about the patient
3. ICD, CPT, HCPCS coding These codes are used to analyze the charts of patients according to the medical specialty and diagnosis
4. Charge entry Charge entry process is consists of different steps which help to provide the services with speed, accuracy or efficiency.
5. Claim submission this process is about to paint the picture of the problem they solve.
6. Payment entry this process includes the registration of patients. This is about to saving up to 40% in the comparison with the existing costs.
7. Denial management sometimes insurance companies deny to paying claims due to inconsistent diagnosis code, wrong modifiers, or incomplete claim form.
8. Reporting helps the billers to make better and correct decisions by getting the correct information about the financial performance.
Medical Billing Process by Different Roles
Now for fulfilling the whole process of according to the steps, without any kind of distortion or problem, everyone in the process is working properly on his concerned job.
Role of Scheduler
This is the duty of scheduler to schedule and to make the appointment of a patient with the health care providers. The other duties of scheduler are to;
· Discuss the insurance methods, issues, and other information with the patient.
· Make sure about the patient’s eligibility by making contact with the insurance companies.
Role of Health Care Provider
The health care provider records the patient’s conditions, symptoms and treatments as well as medical records and to summarize the details of patient’s visit, treatment, condition and other information. This information would be provided to specialist by doctors.
This is the duty of billing specialist to verify the case information to make sure about the information or data if it is correct and valid. Secondly, this is to check the insurance forms to identify the errors that cause rejected claims or unpaid claims.
The duties of account representative include the researches on all rejections from payers and make the corrections accordingly. It also helps in payment problems and insurance billing and also makes payment plans for patients. This role is also responsible for the working with patients and for answering questions related to the account which is a service record by the health care provider.
These roles reviews and if needs, so generate also the reports for giving the support to the workflow. This kind of report includes, daily, weekly, monthly and yearly tasks. The administrator is also responsible for the daily routine operations of the medical billing.
These are the basic rules which are followed by the continuous and ongoing process. Its services give different benefits as well as helping in different aspects which includes;
· It is easy to pay more and faster.
· It gives benefits for the payer rules.
· It provides time consuming work
· It gains full authority to make better decisions according to the demand.
Practices every Medical Biller must know
There are about 8-10 best practices which are every medical biller is supposed to know for the better care and result of practices.
· Checking of eligibility
· Must have understanding of coverage
· Check-in as in administration
· Essentials of medical coding
· Electronically sending the claims
· Secondary claims
· Denials and appealsCollections