Medical Billing Process

With medical billing being so important for most medical practices and facilities, accuracy is critical. Insurance companies quickly deny claims that include inconsistent, inaccurate data, and that can cost a medical practice in additional man hours and lost revenue. Making sure accuracy is a key component throughout the billing process keeps claim denial to a minimum.

Let 's break it down a bit

Pre-registration

When the patient walks through the doors, that is when billing process begins. For accurate billing, you need to gather pertinent demographic and insurance information from each patient. Without that information, the insurance company will not pay the claim.

First-time patients should fill out a detailed data sheet that gathers data

The driver 's license helps verify that the person who came in for the appointment is actually the person on the insurance. The insurance card copy gives the practice all the relevant insurance information for billing.

Verify Insurance Coverage and Policies

You are not providing medical services for free. That is why it is important to verify that the insurance information presented is valid. You also need to verify eligibility and benefits before providing services. Many insurance companies require pre-authorizations and referrals for certain medical specialties or services.

Collect Co-Pays

This seems like a minor step, but it can save you a lot in the long run. By collecting the co-pay up front, you will save yourself the cost of printing statements, adding postage to an envelope, and expending man hours for a 10-dollar co-pay.

Prompt Medical Notation

To ensure the billing process goes forward in a timely fashion, all medical notations should be entered at the time of the patient appointment. If that doesn 't happen, it should happen as soon as possible afterwards. This ensures that the notations are as complete and accurate as possible. Remember, any delay in medical notations will delay the billing and payment cycle.

Coding, Billing Review and Claim

Once the coding is complete, it is time to submit the claim to the insurance company for reimbursement. Before submitting that claim, however, it is reviewed by the billing specialist. This person verifies that all relevant information is included in the claim and that the coding appears accurate. This simple review reduces the number of denied claims and makes the submission process smoother.

If everything looks good, the billing specialist submits the claim to the insurance company.

Insurance Review and Decision

With the claim submitted, everything is in the insurer 's hands. They will review the claim and verify that the policy benefits cover the charges. If the submission is accurate and is covered by the policy, they should approve the claim promptly and pay it as per the agreement with the medical provider.

The Cost of Inaccuracy

The cost of inaccuracy is seen when a claim is denied. At some point in the billing process, accuracy went to the wayside. It could be a simple entry error or a ton of services that the policy doesn 't