medical billing process

Key Steps Of A Successful Medical Billing Process

The medical billing process is the most vital step in the doctor-patient relationship. It ensures the payment of all expenses. It also helps you keep track of your accounts receivable and accounts payable. Successful medical billers or physicians’ earnings are based on the kind of collected revenue. This can only be possible if the medical billing process is flawless. 

Achieving Medical Billing Success With A Few Steps

The medical billing procedure may appear extremely complicated, but it comprises eleven easy steps. These steps are as follows: 

Demographic Entry and Verification

The first and most crucial step is to take down the patient’s information, such as name, gender, residence, and phone number. Insurance-related information is very much essential. It includes 

  • Insurance policy 
  • Policy identification or number 
  • Name of the insurance company

You will be prompted to input the patient’s insurance card while entering the patient’s demographic information. You can also use other documentation that confirms your identity, such as a driver’s license or passport. The demographic data and insurance information must be carefully recorded and maintained if the patient attends the medical practice frequently. They serve as the foundation of a medical claim for rewarding healthcare professionals. The discrepancies between the data entered, and the data in your company’s records can address immediately. Then they do not affect your billing cycle when it comes time to pay these bills! 

Insurance claim submission 

The claim submission process is the first step in a successful medical billing process. Successful claims submission can mean increased revenue for your practice and faster patient turnaround time. The claim submission process should be done accurately and timely so that you don’t end up paying out-of-pocket fees or penalties when there is nothing wrong with your patient’s insurance coverage! This means doing it right from start to finish: following industry guidelines using compliant templates, keeping track of all documentation, and being able to explain why each element matters when presenting any question about this part. 

Charge entry 

This relates to inputting the costs for services provided to the patient. In addition, the charge entry contains the appropriate connection of medical codes to services and treatments performed during the patient’s visit. Charges for services enters in the sheet before collecting from the insurance company. Medical records of patients are carefully monitored and appropriately charged. The charges input will submit to the medical billing company for payment through insurance. Charge input sheets must be error-free or reflected during a claim. Accurate entry requires for quick revenue claims and payment posting. 

Payment processing 

Payment processing is the process of receiving payment from the patient. It can do in two ways: online or offline. Third-party that charges a fee and accepts credit card payments over the web processes online payments. Various offline payment methods, such as checks, cashiers’ checks, or wire transfers. You may also have options for manual payment processing if you prefer to use something other than automated methods. Manual payments allow you to set specific dates when bills are due, so they’ll never fall into arrears again! 

Denial management 

Denials are a common problem in medical billing. The first step to dealing with denials is to understand how they happen. And what can you do to improve your chances of getting paid? It’s important to know that every claim contains a risk factor, but there are steps to minimize this risk. If an insurance company denies your claim for any reason, it usually means one of these things: 

Your patient didn’t meet their eligibility requirements (e.g., age or income)

 Their policy doesn’t cover what you submitted as part of the claim form (e.g., prescription drugs) 

Account receivables management 

The purpose of successful receivables management process is to collect money from patients for services rendered by a medical practice. The four steps in the receivables management process include the following: 

  • Patient Billing 
  • Collections 
  • Follow-Up and Referrals 

Correct Medical Coding and Modifiers 

Your medical scripts will make their way to medical coders. These professionals convert your treatments, diagnoses, and other pertinent data into standardized ICD-10 and CPT codes. Insurers then use these codes to determine whether they will reimburse your customers based on the patient’s health plan. These codes will eventually appear on a medical claim along with your charges and the patient’s demographic information. A procedure code describes the patient’s treatment strategy. To provide more information about the service or process, use appropriate CPT and HCPCS code modifiers. Only with the relevant codes and modifiers can the insurance payer make a proper evaluation. 

Track Claim Adjudication 

Adjudication is the procedure through which payers evaluate valid and compliant medical claims and the amount of reimbursement to the provider. The claim may be approved, rejected, or refused during this process. Insurers reimburse providers for acceptable claims under their agreements with them. A rejected claim contains errors that must be rectified before the claim can be resubmitted. A refused claim is one that the payer declines to pay.

 Patient statement generation 

The patient statement is a document that contains all the information about a patient’s bill. It’s sent to the patient after their medical bill has been processed and treated, so they can download and review it. The statement includes payment options, copays, deductibles, and more. If a non-zero debt occurs from a claim submission for a patient who does not have secondary insurance, you must provide the patient with a statement outlining their charges. You should also send a benefits explanation explaining what the patient gets and does not get with their insurance plan. This way, they’ll understand why, despite having insurance, they owe you money. Payment information and due date include with your patient statements. 

Follow up on the patient’s payment.

The final step in the billing process is to ensure that the bills get paid. Billers are responsible for mailing out exact medical bills on time and following up with patients whose bills are past due. Data is saved in a patient’s file after payment. Billers are responsible for ensuring that the provider is appropriately reimbursed in case of late or half payment. This may entail approaching the patient directly, sending follow-up bills, or, in the worst-case scenario, retaining the services of a collection agency.

Medical billing reports, analytics, and dashboards 

In addition to the core data you need to provide your clients, several other reports and dashboards can be helpful. These include: 

Medical bill status – This report shows how much of the patient’s bill has been paid by insurance companies or Medicare. It also includes an estimate of what percentage of the remaining balance will be covered by insurance coverage in each case. 

Patient satisfaction – This dashboard gives patients an overview of their experience with your practice, including satisfaction with specific aspects like communication, scheduling, and treatment options at their visit. The bottom half of this dashboard advises on what improvements might help make things better for future patients. 

Conclusion

The medical billing process can only be successful if it is flawless. This means that you should do all the steps in the process with proper documentation and customer care.

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