1. Patient Check-in
The very first stage of a patient’s appointment should include the notation of the patient’s demographic information as well as information about his/her insurance, such as the insurance payer and policy number. Any information that will be useful and/or necessary in a claim situation should be detailed at patient check-in.
2. Insurance Eligibility and Verification
Even regular patients need to verify their insurance information and eligibility before every appointment. Insurance information can change at any time, which is why you need to ask patients before every visit if their insurance information has changed. A change in insurance information can also impact benefit and authorization information, so it is always worth the trouble of double-checking.
3. Medical Coding of Diagnosis, Procedures
The correct coding of claims is vital for informing the insurance payer of what exactly the patient is being treated for as well as the method of treatment the patient is undergoing. Be sure to use the correct diagnosis codes to describe the patient’s symptoms or illnesses and the correct procedure codes to describe the patient’s method of treatment. Use accurate CPT and HCPCS code modifiers to provide additional information about the service or procedure performed. The insurance payer can only make an accurate assessment if they have the correct codes and modifiers.
4. Charge Entry
This refers to entering the charges for services that the patient received. The charge entry also includes the appropriate linking of medical codes to services and procedures rendered during the patient’s visit.
5. Claims Submission
Once the claim has been properly completed, it must be submitted to the insurance payer for payment. Medical billers need to have access to the information they need about the insurance payer since there are so many variables for each insurance payer in determining how and when to submit a claim.
While most insurance companies follow a standard set of guidelines for billing, there are some payers who have a separate way of doing things. Certain aspects of medical billing are
6. Payment Posting
This last step involves posting and deposit functions. At this point, the amount billed to the patient will be zero if it has been paid in full or it will reflect the amount owed by the patient. The insurance payer’s responsibility should have been met by this step in the process.
Following these six steps should ensure a smooth experience in the medical billing process. If you got to the end of this list and realized that perhaps your practice isn’t as well prepared as you first thought, Contact us for more information about how we can help you make the medical billing process as simple as possible for your practice. You can also call us directly at 770-666-0470 or email me at firstname.lastname@example.org.