Medical billing is an important process in the healthcare field that follows specific steps to ensure that the providers are properly compensated for their services. While the exact medical billing process can change a bit in the steps taken or with regards to other minor details. However, the end result should be the same and that is that the appropriate parties are billed and payment is received. Here are the steps that are included in the medical billing process, from start to finish:
The registration and financial responsibility process
When a new patient makes an appointment to see a provider for the first time, they will fill out a registration packet that collects information about them. This information will include health history and other facts that will be important for their care.
However, other information includes all the details that are needed to charge the patient, such as their name, address, insurance information, etc. The patient's information, including their insurance information, will be reviewed to determine that all services will be covered by their insurance and if not, that they agree to cover the overages.
The curation and translation of the 'superbill'
The curation of the superbill occurs when the patient has checked out and the necessary information gets forwarded to the medical coder. This is a detailed report of everything relevant to that visit that has been compiled using special software. Once completed, this report will go to the medical biller.
Once the medical biller receives the superbill, they will carefully create the claim using specific formats and coding that adheres to the set standards. Once the claim has been created, it gets submitted to the patient's insurance company. In most cases, these claims are sent electronically.
The patient statement gets generated
Many times, the insurance company will only pay for a portion of the services that the patient has. There are many reasons for this. In some cases, the patient may have deductibles to pay for certain treatments, labs, or tests that they need to meet before their insurance will begin to pay.
In other cases, there may be certain treatments that the patient has done that are not covered at all by their insurance company, while the rest of the visit may be covered. Whatever the case may be, the patient's statement will include any outstanding charges that are still left on their account after their insurance has paid for the portion that they are going to cover. The statement will be provided to the patient and include details about all the charges that are due.
Follow up on payments and non-payments
A medical biller is also responsible for making sure the patient statements are paid. If not, then the medical biller will attempt to get the payment from the patient, even turning the account over to a bill collector if necessary.
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