Streamlining the Medical Billing Process: A Step-by-Step Guide

medical billing cycle steps

In adjudication, a payer evaluates a medical claim and decides whether the claim is valid/compliant and, if so, how much of the claim the payer will reimburse the provider for. It’s at this stage that a claim may be accepted, denied, or rejected. The provider’s office will also collect copayments during patient check-in or check-out.

Verifying insurance details upfront reduces the risk of claim denials and delays. A denied claim is one that the payer refuses to process payment for the medical services rendered. This may occur when a provider bills for a procedure that is not included in a patient’s insurance coverage. This might include a procedure for a pre-existing condition (if the insurance plan does not cover such a procedure). The best way to streamline your medical billing process is through EHR and revenue cycle management tools.

Medical Billing and Coding: Certifications, New Career Opportunities, and Compensation Insights

The superbill contains the name of the service provider, the doctor, the patient, the procedures carried out, the codes for the diagnosis and strategy, and any other relevant medical data. This step entails establishing financial responsibility for a patient visit and includes functions like check-in, insurance eligibility, and verification of the medical billing process. Patient registration is the opening one in the medical billing process. Once a patient calls to line up an appointment with a medical care provider, they or register for his or her doctor’s visit. Once the payer has paid their share, the remainder owed is passed onto the patient in a separate statement. If all goes well, the patient will pay you for your time and effort and the billing cycle that began with their requesting a visit will come to a close.

medical billing cycle steps

Embracing electronic records may help reduce human error and improve the payment funnel for your health system. The CareCredit healthcare credit card helps improve the payment experience for patients and clients, and your financial performance. Using the lens of the patient’s journey, this article will explore the lifecycle of a medical bill, from pre-appointment planning through the follow-up and utilization review.

Medical Coding and Billing: New Programs, Self-Teaching, Examples, and Timelines

Pull up data from patient files to find providers’ contact numbers. Confirm that you’re speaking to the right rep. In some cases, the rep might ask you to share information about your practice to ensure a HIPAA-compliant exchange. Once a secure connection establishes, the operator will release patients’ insurance details. Implementing medical billing cycle steps pre-registration techniques can assist you in improving the patient satisfaction rate. According to a survey conducted by Experian Health, 64% of providers observed that patients preferred an online or mobile-enabled registration experience. You can assign a new patient coordinator (NPC) to simplify registration procedures.

This step may or may not be necessary, depending on whether your patient pays their bill in time. If you don’t receive a payment by the due date, you’ll have to send a follow-up statement. If you don’t receive payment or a response after that, it may be necessary to contact a collection agency. The medical encounter’s audio or video is then transformed into a script form.


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