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What does the medical billing process look like?

The time it takes for a medical claim to be created, submitted, and processed varies depending on a number of factors. The billing process is without a doubt a tedious, time-consuming one, though. If you aren’t familiar with the intricacies of billing medical claims, you might wonder why a seemingly simple task could take days, weeks, or months. Taking a look at each step from beginning to end will give you a better insight into everything that goes into creating just one single medical claim. 

Patient registration

This is where the medical billing data is collected, and it’s an extremely important first step. If your practice is dealing with new patients, you’ll want your staff to collect as much patient information up front as possible, including name, date of birth, address, any medications they’re currently using, and their insurance provider ID. If you’re dealing with a patient who’s already in the system, it’s still important to make sure their insurance provider and coverage haven’t changed. This step is often rushed, resulting in incorrect or incomplete information that later alters claim outcomes. 

Financial responsibility

Claiming financial responsibility simply means that the patient agrees to pay any cost not covered by their insurance provider. 

Patient check in and check out

When a patient arrives for their appointment, they’ll have to fill out some paperwork in addition to providing a valid ID and insurance card. If a copay is owed, the patient could end up paying before or after their appointment, depending on the provider’s policy. When it’s check out time, the information from the appointment is sent to a medical coder to translate into usable code, also known as the superbill. 

Prepare claims 

This is where the magic happens. A claim consists of patient demographic information, the services performed, and the corresponding ICD codes. All claims must meet the billing compliance standards laid out by HIPAA. 

Monitor claim status 

Once a claim is in the payer’s hands, they have to evaluate whether or not the claim can be paid as filed. There are a few different outcomes that can occur at this point. The claim will either be rejected, denied, incorrectly paid, or correctly paid. If a claim isn’t paid correctly, billers usually have the chance to fix and resubmit a claim for proper payment. 

Create patient statements 

The patient statement is a bill consisting of any amount that is still owed after the insurance covers their portion. Often, an Explanation of Benefits is included to explain a patient’s coverage and why certain services may not have been paid for. After this, it’s important for providers to follow up with patients if they haven’t received payment by the specified deadline. 

Commit to better billing with Claimgenix 

The medical billing process isn’t always a simple one, but it’s much simpler with the help of a reliable system. Book your free Claimgenix demo today to see how our medical billing software eases the stress of billing. 

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