Everything that is done in this world has to have a process whether it is an act as simple as cooking a meal or something more complex like the 10 steps to medical billing. If one of these processes or steps is left out, then the result can be disastrous. A cook would not leave out the eggs or the bread when making French toast. The medical billing process is the same, some steps more important than others but each still equally needed. The first step to follow, would be to pre-register the patient into the facility he or she is needing health care.
This means making an appointment for the patient with the attending physician. The symptoms are normally taken to be given to the physician and to be kept in the patient’s medical records. The second step is to establish the financial responsibility for any visits. At step two, the services the insurance plans cover are established. Normally a nurse or practitioner lets the patient know what is covered and what procedure would be considered an out-of-pocket expense. Some plans will pay for two dental cleanings but any cosmetic procedures would be the patient’s responsibility to pay in full.
The third step is to check the patient in to the facility or practice. This normally includes gathering the entire person’s information from the correct spelling of his or her name to their social security number and past health information as well as any insurance information to file. If the patient has visited the physician before, the reason for the visit is normally the only information needed unless otherwise provided such as an address update as well as any understood copay. The fourth step is to check the patient out of the facility or practice for the day.
Even if it is the only visit the patient has with the practice, their medical records would still stay of records for the required amount of time. The medical codes are taken by the medical coder, follow-up appointments are made, and if applicable, any unpaid fees are made aware to the patient. The fifth step is to review the coding compliances. Compliances normally mean making sure all the procedures, information, and codes are correct and satisfactory to the official requirements. Another thing to check is if the medical records are locally linked together.
This follows into step six: checking the billing compliance. All the codes have to have a corresponding fee. Sometimes this fee is set by the facility as a set rate; other codes are not billed. Step seven is to prepare and transmit any claims. This is a major part of medical billing because everything has to be accurate and timely. The medical bill is sent to the insurance payer to have their contribution filed before the non-payable amount is sent to the patient to pay the rest. The eighth step is to monitor payer adjudication.
The payer, such as the insurance company, reviews the bill for any discrepancies. If any are found, an appeal is started. If none are found, then the payer pays their portion. The ninth step is to generate the patient’s statement or statements. The unpaid fee is applied to the patient’s account. A formalized bill is then sent to the address on file explaining the portion paid by the payer and the portion due from the patient. The final and tenth step is to follow up the patient payments and handle any collections.
If the bill continues to go unpaid, numerous bills are sent out again and again for the facilities allotted time frame. In Texas, this is normally up to 90 days before sent to a collection agency. When the patient visits again, the practice normally lets the patient know of any unpaid past due bills and possibly try to work out a payment plan. Everything that is done in this world has to have a process whether it is an act as simple as doing a load of laundry or something more complex like the 10 steps to medical billing. Each step has its use but some steps are more important than others.