Tasks in Medical Billing
Insurance verification
Patient provides the insurance details to the Physician's front office. The Physician's front office verifies the patient's insurance details by calling the insurance company or through online verification.
Patient Demographic Entry
The Patient Demographic entry is the process of capturing all the information of a patient such as his Name, Date of Birth, Sex, SSN, Address, Contact details e.t.c. in the practice management software.
CPT & ICD Coding
The Physician creates the progress note for the Patient encounter. From the progess notes the Coder picks the billable Dx / ICD codes and the Procedure / CPT codes, in some practices the Physician themselves code the ICD and the CPT codes.
Charge Entry
The Charges are entered into the Practice management software and a Claim is generated.
Claim Submission
Once the Claim is generated the claims have to be sent electronically or thru paper depending upon the insurance company. The claims are checked for errors and then submitted to the clearinghouse for onward submission to the insurance companies.
Payment Posting
The payments received from the insurance companies are posted in the practice management software. The Explanation of Benefits received from the insurance companies are reconciled and the denials are also captured.
A/R Follow-up
The insurance companies are called with respect to each outstanding claim and the reason for the denial of the claims is ascertained.
Denial Management
Depending upon the status of each claim and the type of denial, different denial actions need to be taken to ensure that the claim is paid. Prompt and proper denial management will ensure that the Accounts receivable is under control.
Reporting
AR Reports, Aging reports and Collections reports indicate as to how the Accounts receivable is being managed and how the AR is faring across different collection buckets. The practice generates different reports to keep track of collections, performance and for analysis.
- Insurance Verification
- Patient Demographic Entry
- CPT & ICD Coding
- Charge Entry
- Claim Submission
- Payment Posting
- A/R Follow-up
- Denial management
- Reporting
Insurance verification
Patient provides the insurance details to the Physician's front office. The Physician's front office verifies the patient's insurance details by calling the insurance company or through online verification.
Patient Demographic Entry
The Patient Demographic entry is the process of capturing all the information of a patient such as his Name, Date of Birth, Sex, SSN, Address, Contact details e.t.c. in the practice management software.
CPT & ICD Coding
The Physician creates the progress note for the Patient encounter. From the progess notes the Coder picks the billable Dx / ICD codes and the Procedure / CPT codes, in some practices the Physician themselves code the ICD and the CPT codes.
Charge Entry
The Charges are entered into the Practice management software and a Claim is generated.
Claim Submission
Once the Claim is generated the claims have to be sent electronically or thru paper depending upon the insurance company. The claims are checked for errors and then submitted to the clearinghouse for onward submission to the insurance companies.
Payment Posting
The payments received from the insurance companies are posted in the practice management software. The Explanation of Benefits received from the insurance companies are reconciled and the denials are also captured.
A/R Follow-up
The insurance companies are called with respect to each outstanding claim and the reason for the denial of the claims is ascertained.
Denial Management
Depending upon the status of each claim and the type of denial, different denial actions need to be taken to ensure that the claim is paid. Prompt and proper denial management will ensure that the Accounts receivable is under control.
Reporting
AR Reports, Aging reports and Collections reports indicate as to how the Accounts receivable is being managed and how the AR is faring across different collection buckets. The practice generates different reports to keep track of collections, performance and for analysis.
Thanks for describing the medical billing process. I think medical billing outsourcing is the best choice for billing than in-house medical billing by understanding the billing process.
ReplyDeleteThis is a good write-up and explains the medical billing process very well.
ReplyDelete