If you are a healthcare provider and manage your medical billing process alone, you know how incredibly difficult it can be to do so alongside your other responsibilities. It can take quite a lot of time to process just one patient’s payment, and we’re sure you have so many others in the line.
The medical billing process is slow, stressful, and inefficient. You can benefit from hiring a medical billing company to handle this essential yet secondary job. If you think they won’t be worth it and will make you do all the work anyway, let’s discuss how medical billers handle your medical billing for you in these seven steps.
1. REGISTERING THE PATIENT
The entire process, of course, begins with the patient. It starts when the patient first contacts or reaches out to the healthcare provider for an appointment.
If the patient is visiting for the first time, medical billers take all their information at this stage. This includes their demographic information, insurance details, medical history and reports, contact information, and anything else the medical biller deems necessary.
If the patient has already visited before, all the relevant information is saved, and there’s no need to go through the entire process again. However, the medical biller might still reconfirm some details, such as the insurance policy, to ensure all the information is accurate.
It is crucial to record all this information accurately in this first step, as most of it is used in the following steps. Any incorrect details can result in a claim being denied and the healthcare provider not reimbursed.
2. INSURANCE AUTHORIZATION
This step must be carried out correctly the first time, or it can create a lot of trouble for everyone later. After taking the patient’s history and reason for the visit, medical billers need to check that against their insurance policy and ensure it is covered.
There are various health insurance providers, and each has different insurance plans with different coverage. A patient might be coming in for an examination, thinking that the insurance will cover it when actually it is not included in the insurance plan.
Moreover, sometimes, insurance companies change their policies, so something covered before might not be covered now. Therefore, the medical biller checks and authorizes this beforehand to avoid confusion after everything is done.
If the insurance company does not cover a particular procedure or prescription, the patient is notified that he will have to pay himself. Arizona drug rehab explains this well in this informative article.
3. CHECKING IN AND RELEASING THE PATIENT
Checking in and releasing the patient is a pretty simple step. It involves asking the patient to fill in a few forms when he physically comes for his doctor consultation and confirms the information provided before.
This, too, could differ depending on whether it is the patient’s first visit. If it is his first visit, he might have to present some identification or other similar documents as well for verification purposes. After that, he is handed over to the doctor.
4. MEDICAL CODING
Not to sound like a broken record, but this is another vital step in the medical billing process and can play a significant role in determining whether a healthcare provider is compensated. This can even be divided into two steps because it’s crucial.
However, we’ll keep things simple. After the patient is done visiting the doctor, all the details of his visit go to the medical coder. The medical coding team uses this information, such as the diagnosis, treatment, and other services provided, and turns it into medical codes.
These medical codes, along with the patient’s information and other details, are contained in the ‘superbill.’ This superbill eventually goes to the insurance company, which can easily understand everything the patient has undergone by reading the codes.
If the insurance company finds any discrepancy in these codes, they can deny the claim. Therefore, the medical coder spends extra time developing these codes and cross-checking them for accuracy. They also make sure they are compliant with the standards.
5. PREPARING AND SUBMITTING THE CLAIM
Once the medical billers have the superbill containing the codes from the medical coders, they use it to prepare the claim. Different insurance companies demand different formats and procedures, so medical billers make sure that they prepare the claim accordingly.
The claim contains all the patient’s information and the total payment amount the insurance company is expected to pay.
Most insurance companies require the claim to be sent electronically, so that is how the claim is submitted. If there is any error in the codes or format of the claim, it is stopped at this stage.
6. MANAGING CLAIM ADJUDICATION
During this step, the insurance company evaluates the claim on its end. After reviewing the claim, it can be accepted, rejected, or denied. Accepting it means the insurance company didn’t think there was anything wrong with the claim.
If it was rejected, it means that there was some error, which the medical billing company can correct and submit again. If it was denied, it means that the insurance company will not reimburse for those services, perhaps because it’s not part of their coverage.
7. POSTING PAYMENT AND FOLLOWING UP WITH THE PATIENT
After the claim is accepted, the insurance company releases the payment to the medical billing company. They check this payment against their own records, and if everything seems to be in order, they forward it to the healthcare provider. Finally, they let the patient know of the payment details and notify them of any outstanding balance.
Since this is their entire job, you can count on medical billing companies to systematically and efficiently carry out the whole process, as you might have judged by the methodical steps explained above.
Moreover, relying on a medical billing company is excellent for reducing your workload, increasing work efficiency, and improving your revenue cycles and profits. It’s a win-win situation, so we recommend consulting a medical billing company immediately.