A Definitive Guide to Medical Billing Process - I-conic Solutions

A Definitive Guide to Medical Billing Process

Medical Billing is a lengthy and very tedious process. Many human errors take place while claiming the insurance. IF your claims were approved, there are very few chances that insurance companies will pay the claims immediately. The best way to make the process quick and smooth is to follow the step by step; let’s look at the medical billing process in deep to avoid errors.

Register the Patient

Once the new patient visits the hospital, the front desk staff must collect all necessary demographics, health insurance, and other essential details. It is necessary to collect all the information.

During the second visit, front-end staff doesn’t have the ask the same questions, and they have to confirm the same information to make sure that the hospital has the updated and correct information.

Verify the Insurance

Verification of the insurance is quite simple; once the patient information is collected, contact the insurer to confirm the data. The patient’s insurance card has the number to get all the vital information related to insurance.

The most important information to ask is whether insurance is valid and what all are covered in this insurance. If something is not covered in the insurance, the hospital must inform the patient about the same.

Record the Patient’s Notes Effectively

Jot down all the treatments, diagnoses, prescriptions, and services the hospital provides to the patient and enter all the information correctly in the electronic medical records device.

Send the Codes to Medical Billing Team

Once the hospital enters all the information, now is time to send all the vital information to the medical billing. Don’t forget to convert the notes into the medical script so that the medical billing team can read and start working on that.

In many cases, the notes are in the voice format again hospital must change that voice into the medical script so that the medical billing team can understand.

Convert Medical Script into ICD-10 & CPT Codes

Once the hospital is ready with the medical scripts, medical coders come into the picture and convert the medical script to the standard format of ICD-10 and CPT codes. Medical Coders can easily translate your treatments, diagnoses, prescription into ICD-10 and CPT codes so that insurance companies can use these codes to assess the medical claim.

Add the Correct Charges for the Claims

Once the standardized script is ready, charges must be added, and the amounts vary from service to service. In addition, the charges hospital has to mention if the patients cover any costs.

File your Claims

Once all the records and the numbers are ready, there are high chances of error. Recheck all the details that will help correct the mistakes, if not all the errors, but still, you can find most of the mistakes.

Now it’s time to file the claim; you can directly do the filing, and if it’s outsourced, that medical billing company can do it for you.

Payers Adjudication

Once the insurance company receives the claims, the adjudication comments; in this process, the payer will check how much can be reimbursed or whether the claim can be approved, rejected, or denied. Most of the emails are rejected due to errors in medical coding.

Sometimes claims are denied, and the patient has to pay the amount that must be informed to the customer.

Send Patient’s Statement

In this step, hospitals have to send a detailed explanation of the status of the emails so that patients are aware of the next step. For example, if the claim was denied, a detailed explanation has to be sent related to denial, and if they have to pay some amouth, that also has to be mentioned.

Pursue Payment

If your claim was approved, then the pursuit of the payments begins. Claims approval and reimbursement take time, along pursuing compensation is also a time-consuming process.

Conclusion

The medical Billing process is quite tedious, and there might be many reasons why claims are rejected. However, if one follows the steps mentioned above, there are high chances that the complete process takes less time and hospitals get the money a little early.

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