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7 Signs You Have a Great Medical Billing Process

April 30, 2015


The livelihood of your practice requires you to have the right procedures in place when it comes to medical billing. If even one aspect of this process is off, it can affect greatly affect your profits. Here are 7 signs you have a great medical billing process, so you can tailor yours to achieve the best results possible.

#1. Patient check in

During check-in, patients should verify the demographic information needed to process an accurate claim. This includes insurance payer and policy number, if applicable.

#2. Insurance eligibility and verification

Even if a patient has been seen rather recently, his or her insurance information could nonetheless have changed since the last visit. For this reason, it’s essential to verify insurance eligibility during each and every visit. Doing so will also ensure you have accurate benefit and authorization information.

#3. Charge entry

During this stage of the process, you will enter charges, applying the appropriate medical codes for the services and procedures provided during the visit.

#4. Coding of diagnosis, procedure and modifiers

Coding claims must be done accurately in order to advise the payer of the patient’s injury or illness in addition to the method of treatment. Codes that may be used include:

  • Diagnosis codes, which describe the patient’s illness or particular symptoms (ICD-9 or ICD-10)
  • Procedure codes that describe the method of treatment provided to the patient (CPT or HCPCS)
  • CPT and HCPCS code modifiers to provide additional information about a particular procedure 

#5. Claims submission

Once the appropriate information has been added, the claim should then be submitted to the insurance carrier. This requires billing specialists to have the right information on hand for each company, since each one has specific criteria that must be met in order to receive claims. Failing to follow even one of the requirements can result in a claim being denied.

#6. Payment posting

Payment posting is actually a multi-step process that involves:

  • Posting payments
  • Depositing money into the appropriate accounts
  • Reconciling postings with deposits
  • Documenting payments to the patient’s account

#7. Secondary Functions

Several things may be needed whenever the billing process does not quite go as planned. A few secondary actions that may be taken include:

  • Following up with an insurance company to ensure a claim was received. This should ideally be done between seven and ten days after submission.
  • Resubmitting claims when corrections are needed
  • Appealing claims denied for reasons other than registration errors

When all the above steps are taken, you should notice a tremendous improvement in accounts receivable. For this reason, it makes good sense to trust your medical billing and coding efforts to an experienced, reliable company such as M-Scribe. To find out how we can help you improve your billing and coding functions, contact us.


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