What is Medical Billing?

If we define Medical Billing it is basically a payment practice or process for a healthcare system of getting a physician paid for their services. More or less the same practice is followed in each country for the medical service provided to patients. But here we will discuss what is medical billing within the United States healthcare system and what are the steps in the medical billing process?

What are the steps in the medical billing process?

There are several steps in the medical billing process, below are the most common steps to understand the medical billing process in a simple way.

Below is the flowchart of the medical billing process, and I will explain each step one by one.

What are the steps in the medical billing process?

Medical Billing Process (Image Ref: https://www.freemedicalbillingtraining.com)

1- Patient Visit

The medical billing process starts with a patient visit to a physician clinic, Urgent care Center, Hospital, or any other healthcare facility. A patient can visit any physician clinic by walk-in or through a scheduled appointment, but for hospital and urgent care’s patients can visit them on an urgent basis.

2- Patient Registration

When a patient arrives in a physician clinic, urgent care, or hospital, the next step is patient registration. Administration staff at the front desk will provide a registration form to the patient or they will take the information to enter into the registration system. The patient registration form includes information about the patient, Insurance information, billing address, contact information, etc. After the administration staff has the registration information, the physician evaluates the patient.

3- Medical Documentation

During the patient’s evaluation process or treatment, physician or nurse documents all the procedures, treatments, diagnoses, prescriptions, etc in paper format or in EHR (Electronic Health Records). It is also called, Medical records, Medical Notes, and Clinical information, etc.

4- Medical Coding

Once medical documentation is completed by a physician, specialist coders take this information to assign appropriate Procedures Codes/CPT’s and Diagnosis for the billing team.

5- Medical Billing

Medical billers enter these procedures/CPT’s, Diagnosis, and Date of Service into Billing Software and get the claims ready for Insurance Submission.

6- Claim Submission to Insurance

Once claims are ready from the billing team, they are sent to the Insurance either as paper mail out or through electronic submission. If the claim is being submitted electronically, the claim will be filtered by a Clearing House to make sure that a clean claim is being submitted to the Insurance without any error.

7- Followup with Insurance

Once the claim is submitted to Insurance, Insurance will review the claim, and the physician will be paid by the Insurance company. If payment isn’t received in a standard time frame than the billing team will follow-up with the Insurance company to inquire if the claim is paid, or denied and if denied what is the reason or required information to get the claim paid.

8- Physician Paid by Insurance

Explanation of the paid claim is either sent in an electronic format “ERA” or in a paper format “EOB” that is mailed out on the physician’s address. Payments are made either directly into the bank or a check is issued along with “EOB” in the physician’s name and the physician can deposit it into the bank.

9- Payment Posting

Once the billing team has received the ERA or EOB, they will post the payment information into the Billing Software against the claim that was sent to the Insurance.

10- Patient Statement

Once the payment is posted into the Billing Software, the last step is to send the patient statements for any patient responsibility left by the Insurance company in terms of Coinsurance, Copay, or Deductible. Patient statements are mailed out on the patient’s mailing address and the patient sends the payments to the physician. Normally, Copay is paid by the patients upfront at the time of the visit.

 

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