The Medical Billing Process Flow

Monday, October 1, 2012 10:12 Share
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The medical billing and coding process is considered one of the key challenges faced by the healthcare domain. Each and every step involved in this intricate process has its own significance and only medical billing specialists can carry them out efficiently. Therefore, healthcare facilities and independent medical practitioners can take full advantage of medical billing companies or offshore vendors for desired results. Here is a brief elucidation of the medical billing process flow,   

Patient Demographics Entry: In this process, a patient’s personal details along with vital information like POS (Place of Service) and DOS (Date of Service) are recorded. Meanwhile, the authenticity of the patient’s insurance credentials is also verified for further processing.

Secure Registration: A highly professional medical billing company will give great importance to this process to earn the goodwill of the client as well as being HIPAA compliant. A secure VPN connection to the medical billing system is established to transmit medical records via FTP.

Medical Coding: The medical records will be retrieved and reviewed by a medical coder, who will then assign alphanumeric codes for the patient’s demographics and the services rendered. For instance, the procedures are coded as per the Current Procedural Terminology (CPT) and diagnoses based on the International Classification of Diseases (ICD-9) manual.

Charge Entry: Once the coding part is done, medical billing specialists assign the appropriate charges for the corresponding patient based on the coding standards. These charges are responsible for determining the reimbursements for the services rendered by a healthcare facility or an individual physician. It is the most critical step in the medical billing and coding cycle, as even a minor error will greatly impact the outcome. Rummaging around the entire process to find that error will be like finding ‘a needle in a haystack’.

Claims Submission: In this step, medical billing specialists prepare appropriate claim forms for the corresponding patient and submit the same to the insurance company. It is done by electronic means so as to save time.

Payment Posting: It is one of the crucial processes, which helps in enhancing productivity and profitability. The claims are reviewed by the insurance company to generate appropriate results and payment settlements pertaining to the patient’s accounts. The status will be monitored by the medical billing specialists on a regular basis to ensure timely payment of claims and reconciled with the Charges already created in the billing system.

Denial Management: As the medical billing and coding process is error-prone, mistakes are unavoidable, so some claims may get rejected. Such rejected claims will be brought into the notice of a highly qualified team of professionals to quickly analyze and correct the error for re-submissions and appealing.

Collections Management: An expert team in the medical billing company will help in managing the receivable insurance and patient accounts to improve cash flow. In turn, it contributes to a healthy revenue cycle management.

Management Reporting: As a final step of the medical billing process, the status of the revenue cycle and concrete feedback are sent to the client in the form of reports.

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