...Steps in the Medical Billing Process Stacy Dickson HCR/220 March 20, 2011 Alexander Mejia Steps in the Medical Billing Process The medical billing process is one that requires attention to detail to ensure that all the proper paperwork is completed properly and accurately. This process will begin form the time the patient enters to register for their appointment until after they have finished their appointment. This paper will provide the step by step process. Visit Step 1 Preregister Patients As part of the medical billing process, preregistering patients is required. This could be scheduling a patient for an appointment or it could be to update a patients appointments. This also allows insurance information to be updated in the patient’s files and to retrieve any demographic information. The medical scheduler will also inquire for the reason of the visit so that the appropriate amount of time is allotted for the visit. Step 2 Evaluate Financial Responsibility Evaluating the financial responsibility of the visit is extremely important, to ensure that the patients insurance covers and what the patients is responsible for. It is also establish if any prior authorizations are required before services are performed. Step 3 Check In Patients When a patient new patient arrives it is necessary to take a copy of their insurance card, drivers’ license, and have them complete a new patient form with their medical history, home address...
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...Steps in the Medical Billing Process Annette Callen 02/11/2012 I am writing this paper to discuss the ten steps of medical billing. The ten step process consist of patient preregister, establish financial responsibility for visits, check in patients, check out patients, review coding compliance, check billing compliance, prepare and transmit claims, monitor payer adjudication, generate patient statements and follow up patient payments and handle collections. These steps are under three categories these categories are visit, claim and post-claim; throughout this paper I will explain each of these ten steps. The first category is visit; step one of visit is preregister patients. This step usually involves the clerks at the front desk or nurses depending on the size and location of the health center. The clerks are responsible for checking in patients, scheduling appointments and making appointment reminder calls. The clerks are also responsible for collecting the patient personal and payer information. Step two is establishing financial responsibility for the health visit. This step is where the clerks will collect the payer insurance information, set up a payment plan, and let the nurses and doctors know what is covered by the insurance company such as treatments, testing and medications. If the patient does not have medical insurance then the clerks need to determine if the patient needs to be on a payment plan or if they can pay for the service in one...
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...2015 Ten Step Billing Process The ten steps of the medical billing process have been divided into three categories: The visit, the claim and the post claim. Following the billing steps to complete correct claims ensures that providers are paid accurately and timely for services and procedures. The Billing process begins with the preregistration of patients. Collecting personal, basic demographic information, and insurance information and entering that information into the database. All of this personal information can be referred to at any time during the medical billing process. Keeping up to date patient and insurance information makes patient check in more efficient and eliminated potential billing errors. Confirming financial responsibility is the next step in the billing process. Once a patient’s information has been updated in the computer system it is then the medical staffs’ responsibility to determine who will be paying for the services rendered for the appointment. Insurance providers are contacted and benefits are verified as different plans have different levels of coverage. Once the medical staff is aware of what the allowable insurance benefits are, contact with the patient should be made so the patient is aware of their responsibility for out of pocket, non-covered expenses, co-payments, and deductibles. During the appointment, the physician makes notes of the examination and services provided. These notes become part of the patients’ medical records...
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...The medical billing process is a process in which by medical billing specialist to provide maximum, payments for medical services that are provided. The medical billing process contains ten steps and these steps are made up of three categories: The visit, the claim, and post claim. During the visit steps one through four occurs. Pre-registering the patient is the first step. This where an appointment is scheduled and updates are made to pre-register the patient. Collection of all information such as, insurance and demographics on the patient is collected during this visit. Reason for the visit is provided at this time. Determining the patient’s financial responsibility is the second step. If the patient has insurance coverage verification of patients eligibility must be made .The patient is responsible to pay whatever percent of the bill that the insurance does not cover and if no insurance is provided the patient is responsible for the cost of all services that have been provided. The third step of the process is checking the patient in. New patients are required to provide medical insurance if available and medical information is collected for the patients’ file. If patient is a returning patient then information is verified and if any information is incorrect or has changed then it is then updated. Photocopies of Drivers licenses and insurance cards are taken and filed in the patients’ record. If there are any Co-payments that need to be made are...
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...Medical Billing Process There are several different steps in the medical billing process that have to be followed. Each step is very unique and should be followed accordingly. The first step in the medical billing process is to pre-register all patients. This process requires you to schedule patients for new treatment. You are also required to update appointments for new and old patients. Upon preregistration it is also your job to collect both demographic and all of the patients insurance information. Patients have to provide their reason for the desired appointment so that proper treatment can be scheduled and provided. The next step in the medical billing process is to establish financial responsibility. During this process, determining if an insured patient has enough coverage for the type of visit is determined. Patients will be asked a series of questions about the type of insurance they have and the healthcare facility will of course run the insurance to see if it will pay for the visit and the service. If certain services are not covered by the patients insurance, then the patient will be informed and further actions will be taken. It is very important that the financial information is taken upfront. I say this because patients who do not have the appropriate health insurance will be treated and in the end cannot pay, causing the healthcare facility to lose money. The third step in the medical billing process is to check in patients. This step applies to patients...
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...Medical Billing and Reimbursement Grand Canyon University: HCA-530-0101 July 14, 2015 Healthcare organizations’ services provided are civic and moral in nature. These services are directly impacting a society and community’s ability to function and be productive. One might say, healthcare organizations must always prioritize the moral objective or vision at all times, however, in order for healthcare organizations to continue providing access to healthcare, these organizations must be financially sound. Revenue stream is one area that initiates an organizations ability or inability to thrive. Billing accurately and timely for these services will ensure revenues are collected avoiding delay in providing healthcare to the community. According to Cleverley, Song, & Cleverley, 2011, p. 14), “Healthcare firms are for the most part business-oriented organizations. Their ultimate financial survival depends on a consistent and recurring flow of funds from the services they provide to patients. Without an adequate stream of revenue these firms would be forced to cease operations”. A critical role in ensuring that there is an adequate stream of revenue in a healthcare organization is the medical coder/biller. This role is tasked to start, process and file a claim to a patient’s insurance (private or government) for reimbursement. These claims are the lifeline of an organization’s revenues and must be process correctly to ensure all services provided will be paid. There are seemingly...
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...Medical billing is a process that doctors and insurance companies use. Doctors use the process to submit claims to insurance companies so they can be paid for their serves rendered. The billing process consists of 10 steps. These steps have been broken down into three different categories. The visit, the claim, and the post claim. The first category consists of the first four steps. The first step in this category is “The Visit”. During this step the patient is pre-registered. A returning patient or a new patient is pre-registered by making appointments for a future visit or an appointment to start serves. Each patient upon their visit is as asked for their insurance information and demographic information. Returning patients and new patients are to provide the facility with the medical purpose of the visit. Step two is to determine what the patient’s financial responsibility will be. The patients insurance usually has a set payment, which is usually 80/20. The insurance will pay 80% of the bill and the patient is responsible for 20% of the bill. For patients that are uninsured, the patient is responsible for all of the medical charges. Step three, the patient actually gets check-in. Returning patients are asked if all information is still the same as the last visit. Which includes insurance, address, phone number, ect. New patients are asked for all medical and insurance information. All patients are asked for proof of insurance cards and identification, which are photocopied...
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...Medical Billing Process Nathia Herod HCR/220 2/26/2012 Melinda Sousa Medical Billing Process There comes the time in everyone’s life that just about almost everyone who is adults has gone through some part of the medical billing process. It is a process in what keeps most workers in the field their job and some patients their health. In the end, in order for everyone to be satisfied, everyone must play their role and work together. In order for the patient to understand what they are paying for; the biller must know who to bill and what they are paying for as well. There are ten steps of the medical billing process and the first step of this process would be to always pre-register the patients. When you break this step down a little further all it means is that you are setting appointments for the patient but first thing’s first, you must get their insurance in order to know what the patient is going to pay and what they are not going to pay. When the patient is done being preregistered; you are now available to state their financial responsibility for the visit. Most of the time when patients are preregistered, they kind of already have a prejudgment as to what they are going to pay because of their insurance which also establishes a financial responsibility. You must clarify clearly in the beginning as to why they are paying for this and not paying for something else. You must always try your best to get the patient to understand or else there will be a lot...
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...University of Phoenix Material Accurate Registration Worksheet In 50 to 100 words, explain each step of the medical billing cycle, using Figure 6.7 of Integrated Electronic Health Records as a reference. Your explanations must be in your own words. Step Explanation 1 Pre-registration confirms the patient’s information and helps to identity the patient to ensure the patient safety. This is an important step especial for reoccurring patients... This step also helps with verifying a patients insurance. Pre-registration gives the office ample time to answer questions before they are asked by looking into the EHR. Pre-registration also allows you to see procedures that may require prior authorization (pre-cert). 2 Establish financial responsibility- Establishing financial responsibility is knowing who owes what for a certain doctor’s visits. Once the clinic gathers the pertinent information from the patient, then the biller can then determine which services are covered and allowed under the patient’s insurance plan. Insurance coverage can differ hugely between companies, individual, and plans, The biller needs to make sure each patient’s coverage in order to create the bill correctly. This also goes for prescriptions, some insurance companies do not allow for certain types or prefer generics. 3 Check in patients- Patient check-in and check-out are pretty much straight-at the desk task. When the comes in, First time patients will be asked to fill out paper forms or...
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...Evaluating Compliance Strategies Patricia Estrada HCR/220 November 2012 Deborah Ryan Medical billing and compliance strategies are used to bill for medical procedures and treatments. The compliance strategies are in place to prevent incorrect billing, but mistakes are still made. Answers to the importance of correctly linking procedures and diagnoses, the implications of incorrect medical coding, and how medical coding, physicians and payer fees are related to the compliance process will be discussed. It is very important that procedures and diagnosis are correctly linked together. There are certain steps to follow that help to correctly link the procedure to the diagnoses. By following the correct procedures to apply the correct codes that link procedure with diagnosis, insurance companies can be correctly billed for reimbursements. Correctly connected claims can be analyzed and to make sure charges are for medically necessary services provided to the patient. Correct claims help reduce the chance of an investigation of the practice of fraud and the risk of liability in an investigation does occur. (Valerius, J., Bayes, N., Newby, C., & Seggern, J. , 2008). If the procedures are not linked correctly to the diagnoses, then they will not be covered by the insurance company and therefor will not be paid. The major implication of incorrect medical coding would be fraud. Even though incorrect work may simply be an error, it may also represent a deliberate attempt...
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...Evaluating Compliance Strategies HCR/220 Compliant billing involves certain steps in order to properly bill a patient and receive any monies owed for those services performed. First step is for the doctor to fill out and sign any and all forms at the end of a patient’s visit. The next step is to post the transactions made along with the proper medical codes from a patient’s appointment into the practice management program which leads to the claims being filed. Payers then need to make sure that the services performed along with the diagnosis must show that it was medically necessary services. The billers also need to know the proper rules and guidelines put forth by a patient’s insurance company. Because medical insurance companies constantly change their policies, the insurance specialist rely on the payer’s website or may regular communicate with a representative of the payer. The correct coding initiative controls improper coding that would result in improper payments for Medicare claims. The CCI also monitors billing of any services that Medicare believes cannot be performed together. The CCI also requires doctors to tell about the most extensive service that was performed and not the revealing of both the extensive and limited services. Finally the CCI also tests for unbundling. Many mistakes can be made while billing/coding a patient. Some of those mistakes are: billing invalid/outdated codes, coding without the correct forms, truncated coding; using codes that...
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...Medical Billing Process HCA 220 11-03-13 Axia University of Phoenix Medical Billing Process When you go to the health care provider’s office for care, the admitting or office registration department gathers information about you the person responsible for paying for the services and the insurance that will be billed. Step 1: Pre register Patients. By scheduling and updating appointments get the patients demographic and insurance information. Step 2: Establish Financial Responsibility for their visits – verify insurance eligibility and figure out how much to collect from the patient. You get this info by figuring what services are covered by the plan and what services are not covered, and if there are any billing rules to the plan. Step 3: Check in Patients have them sign in then collect whatever necessary money from them, and copy or scan their current insurance card. When this is a new patient they collect detailed and complete demographic and medical information. A regular patient would need to verify their demographic and medical information is correct. Step 4: Review Coding Compliance. Compliance means actions that satisfy official requirements, with coding compliance means following official guidelines when codes are assigned. Obtain CPT and ICD-9 from the doctor(s) next verifies all information is correct before entering it into the computer system. Step 5: Review Billing Compliance. This is where you need to figure out which fee is associated...
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...UNDERSTANDING MEDICAL INSURANCE KEY TERMS Step 1 S te St ep 10 Follow up payments and collections Preregister patients p2 Establish financial responsibility St ep 3 S te p 9 Generate patient statements Check in patients Monitor payer adjudication Review coding compliance St ep 8 S te Check out patients Review billing compliance p7 St ep 5 S tep 6 Learning Outcomes After studying this chapter, you should be able to: 1.1 Explain how healthy practice finances depend on correctly accomplishing administrative tasks in the medical office. 1.2 Compare coinsurance and copayment requirements for health Copyright © 2014 The McGraw-Hill Companies plan benefits. 1.3 Identify the key steps in the medical billing cycle. 1.4 Discuss the impact of electronic health records on clinical and billing workflow. 1.5 Evaluate the importance of professional certification and of medical liability insurance for career advancement. S te p4 Medical Billing Cycle Prepare and transmit claims 1 accounts payable (AP) accounts receivable (AR) benefits cash flow certification coding coinsurance copayment covered services deductible diagnosis documentation electronic claim (e-claim) electronic health record (EHR) fee-for-service health care claim health information technology (HIT) health plan indemnity plan managed care managed care organization (MCO) medical assistant ...
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...established by HIPAA are what make up the compliance process. These laws and guidelines were established to protect the patients, physicians, and staff members” (U.S. Dept. of Health and Human Services, n.d.). Errors in the office can be avoided by having a compliance process in effect. Using updated billing and coding software will help reduce errors made in the billing process. I agree with having a guide consisting of codes to aid in the billing process. I do regard this as cheating rather, to be used as a guide. Many offices currently have sheets that are located on the front of the patients’ file with the diagnosis and the code next to the diagnosis which the physician fills out. This eliminates an unnecessary step in the billing process and is a quicker, easier, and more accurate way to avoid errors. “In order to avoid rejection of the claim, it is important that the diagnoses and procedures are correctly linked” (AAFP, 1999). This also ensures that the claim is paid for the correct procedure performed by the physician. If an incorrect procedure was billed this could result in a loss of money by the physician for the type of procedure that was performed. The claim will have to be adjusted and resubmitted to the insurance company if the claim is rejected. These mistakes can cause the physicians’ accounts receivable to be out of balance, and result in claims left outstanding for payment. “The repercussions of incorrect medical coding can result in lost revenue, which could...
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...University of Phoenix Material Steps in the Medical Billing Process Part A Reference: Ch. 1 of Medical Insurance Complete the following table by identifying the 10 steps in the Medical Billing Process. Write 2 to 3 sentences describing each step. Be as specific as possible. For example, Step 1 may be, “Preregister Patients.” |Step |Description | |Step 1: Preregister patients |The patient schedules and appointment to see the doctor. The doctor’s office collects | | |preregistration demographics and insurance information. Appointments are updated if | | |needed. | |Step 2: Establish financial responsibility |Once the appointment is made now you have to see what is covered under the patient’s | | |insurance plan. What is not covered? You also need to find out the billing rules of the | | |patients insurance. | |Step 3: Check in patients |When the patient arrives for their appointment they are to sign in. Once they do that new| | ...
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