Monday April 1, 2024
The medical billing process is all about the conversion of the notes generated during a patient's appointment to numbers. However, this is not the end of the billing process; the reason why medical billing is frustrating and complex is because of the intermediary steps involved. The accuracy and precision of each step are crucial to avoid billing errors.
Without execution of a proper medical billing process, the reimbursements against your services seems to be a hard nut to crack. Moreover, if you still perform a few of the steps, the reimbursements are still not guaranteed until and unless you have hired the medical billing experts or a medical billing company. These hired professionals know how to bill and how to get the refunds by following all the necessary medical billing steps expertly.
Let's dive into the depths of this blog to learn more about the steps involved in the medical billing process and how to execute each step with precision.
Everything works well when executed by performing the crucial steps the right way and at the right time. Medical billing is also one of the activities that demand execution in a professional and accurate manner to meet a successful end. The omission of any of these steps results in the inaccuracy of the bills generated and claims submitted which in return affect the revenue and financial status of your practice.
Below are the necessary steps that are crucial to perform for the success and accuracy of medical billing.
The first and foremost step of the medical billing process is gathering useful patient data. Gathering the required patient information begins as soon as the patient schedules the appointment. This demographic inquiry includes the patient's name, age, contact details, and, most importantly, insurance payer details.
These details play a significant part in the medical billing process because this is where one gets to know about the responsible payer. However, it is also a crucial part of the medical billing process that the medical billing company is aware of the importance of HIPAA compliance.
One crucial step of medical billing is determining who is responsible for the financial responsibility of the treatments offered to the patient. Based on the information gathered in the first process, it is pivotal to confirm the authenticity of the details by contacting the insurance payer.
This process must be executed before the patient has received any treatments or undergone any procedures. It helps identify the financial responsibility and avoid conflicts after the services are offered to the patient.
Once the demographics and insurance payer verification are confirmed, it is time to document the list of processes and procedures during an appointment. Documenting every service offered, from minor to major, is crucial so that the exact amounts are billed.
While jotting down this information, one must know that missing out on any single procedure or service offered will affect the collected amount. You need to document everything, even the information mentioned on the patient’s report, because it also contains some information about the procedures performed.
4. Document conversion
Medical billing services usually pay less attention to this process, but professionals consider it important. The document conversion step organizes and structures the document prepared in the previous process.
Although the information regarding the procedures and services rendered is completed in the previous process, this is done to make the billing process less error-prone and complex. With organized information about the tools, procedures, and services, billing for them becomes less complex.
Once the documentation is complete, the medical coder hops in. The medical coder is responsible for generating CPT codes against each procedure, treatment, and diagnosis. It is better to outsource medical coding services instead of opting to do it in-house.
The outsourced medical coder will convert every detail, I.e., the treatment or diagnosis, into codes that are submitted to the insurance payers. With these codes generated, the insurance payer decides whether the treatments and services rendered to the patient fall under their insurance policy or not.
Based on the CPT codes, medical bills are generated stating the actual amount to be paid. Converting the medical codes into medical bills is one crucial step that demands high accuracy and precision. Expert help and supervision are necessary to achieve this accuracy in the medical bills.
Failure to bill accurately will result in claim denials and no reimbursements. There should be no differences between the CPT codes and the amounts written against them. This medical billing step is also known as charge entry, where the actual charges for the codes are entered.
Many billing services may not follow this step, but it is one of the most significant yet less popular medical billing steps. Before you begin the claim submission process, soon after the medical bills are generated, it is pivotal to go for claim scrubbing.
Claim scrubbing is a medical billing process that revises the generated claims and looks for any errors. The addition of this extra step to the medical billing process enhances the accuracy levels. Any errors and discrepancies in the medical bills are corrected in this step.
This is the medical billing step where the billing process is accelerated, and you get to see any response from the insurance payer. Claim submission, as the name itself signifies, is a process where the generated claims are submitted to the insurance payer.
One thing that you need to keep in mind while submitting these claims is to submit the right and required documents. With no documentation, you may face rejections and denials and the insurance payer may not agree to pay the amounts even when the bills are accurate.
Many medical billing services may not offer you the adjudication monitoring service, but it is an important step. This is a step where the insurance payer or to whom the claims are submitted responds with the amount they are liable to pay according to their insurance plan.
This does not mean that the claims are rejected; rather, it means that the claims are accepted and the amount that they are bound to pay will be paid. Monitoring this adjudication will help you get the reimbursements quickly because you know who will be the next one to whom you will be sending the bills.
Based on the responses and results of the adjudication monitoring, the amount that does not fall in their insurance plan must be paid by the patient. However, some of the medical billing companies investigate the insurance payer payment plan beforehand; if not, then they need to opt for patient statement preparations.
In the patient statement, the remaining amounts are mentioned and billed. These bills are submitted to the patient, and the process is monitored till the pending amounts are reimbursed.
There are possibilities that the insurance payer may refuse to pay the mentioned billed due to several reasons. But one of the prominent reason behind these denials is the inaccuracy or ambiguity of the medical bills. These denials must not be left unattended if reimbursements are what you expect.
The medical billing team must proceed with the denial management and do the required communications and billing corrections. It is their responsibility to pinpoint the reasons for denials and resubmit the claims for quick reimbursements.
For many medical billing services, the medical billing process ends with the submission of the claims. But there are a few medical billing services that not only offer billing services for various medical specialties, but also stay with you after the claims are submitted.
These billing services will follow-up on the claims that are submitted and stay in contact and coordination with the payer. This coordination ensures the timely payment of the pending amount.
One of the most crucial steps in the medical billing process is accounts receivable management. Knowing the number of payments received and which ones need to be received is crucial for revenue cycle management.
The medical billing team will be responsible for monitoring the flow of the payments received and inquiring about the ones that are due for a very long period. These A/R management steps are crucial to keep your practice revenue growing and deal with the payment overdues that are hindering this growth.
The solution to your medical billing problems and complexities is just one: hiring expert medical billing services. You will have to work on choosing the best medical billing company for your desired success. These hired services are aware of the necessary steps to produce an error-free medical bill, ensuring increased collection rates. Make sure to hire medical billing services that include the execution of every medical billing process for guaranteed success and accuracy.
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