10 Solid Steps Of Medical Billing Process In 2022
In today’s healthcare environment, there are numerous challenges in reducing medical billing errors, adhering to the latest billing regulations, and optimizing the entire billing process. To simplify the daily work burden faced by hospitals and other healthcare facilities, here are the 10 effective steps of the medical billing process in 2022 explained.
1. Patient Demographics Entry (Patient Registration)
Collecting accurate patient information is one of the most under-rated processes in revenue cycle management. Not only does the data captured in the patient registration process create a base for the medical record, but it also affects the insurance claim payment.
In this process, the responsible staff should accurately capture the patient data either via paper-based registration or via an online scheduling system.
The error-free capture of patient information during the process of registration is essential for clean claim submission, obtaining prior authorization, and more.
The patient registration process
- Greet your patients during their visit
- If a patient is new to your clinic, provide them with a registration form
- Also, provide a HIPAA privacy notice regards to Protected Health Information
- Make a copy of your patient’s insurance card for further procedures
- You can create a new patient account or update an existing account with the help of a patient registration form
- If you are using paper-based methods, create a new encounter form to attach to the patient file.
2. Insurance Eligibility Verification
The insurance eligibility verification of a patient is important to ensure that the patient has proper coverage, healthcare services that are being provided are covered, denials can be minimized and payments are expedited at the proper rates.
Most importantly, insurance verification should be done before a patient receives his/her medical services. Failing to do so results in unpaid claims and provide patients with unexpected expensive bills.
3. Patient Encounter
The patient encounter is used to manage information on a patient’s stay in the hospital or clinic. When a patient visits a physician for consultation, the details of the patient's health condition or the treatments offered are recorded either by audio or video. This may be done in front of the patient or after the encounter.
The patient encounter form includes the following fields
- Patient name
- Reference number
- Place of service
- Date of the patient encounter.
- Advanced Beneficiary Notice (ABN)
- Procedure list
- Doctor's Signature
- Amount paid
- Diagnoses list
- Practice and physician information
The importance of patient encounters is that it gives a clear understanding of the patient's healthcare condition and the medications that the physician had prescribed.
This will be later submitted to the revenue cycle management service provider to process medical billing and claim the revenue.
4. Medical Transcription
The recorded audio or video about the patient's health condition and services offered by the physicians is transferred into a medical script is known as medical transcription.
These notes can include everything from patient clinical summaries to surgery notes. One should make sure that the transcription does not include any wrong data about the patient’s health condition, as it might put the patient’s health at risk.
5. Medical Coding
Medical coding is the process of transformation of healthcare procedures, diagnoses, and medical services into medical codes. The procedure codes are taken from the documentation such as transcription of physician’s notes, laboratory results, etc.
The expert medical coding professionals help to ensure the medical codes are applied correctly during the medical billing process. The medical coders mostly rely on DX, and CPT to transcript the health record into medical coding.
Importance Of Medical Coding
- Medical coding helps to reduce operating cost
- It minimizes claim denials
- Results in better focus on healthcare
6. Charge Entry
Charge entry is a process of entering important data into a sheet to enable claim processing. Individual patients’ medical records are continuously monitored and charged with an appropriate value.
All the values entered in the charge entry sheet should be error-free and in an approved manner. The entered charges will be claimed by the medical billing firm with insurance for reimbursement.
1. Medical billing information entry
Here the patient’s medical billing data should be entered accurately. This is considered to be one of the important steps in charge entry.
2. Assignment of Charges for medical codes
This stage requires an expert medical billing professional who is well versed in medical coding systems to carry out.
7. Charge Transmission
Transmitting the claims with accurate coding through EDI (Electronic Data Interchange) to the insurance company is called Charge transmission. Only clean claims without errors will be transmitted through EDI.
Transmission errors carry three levels
Mandatory fields have to be filled without any mistakes. Otherwise, the software would reject the claim.
2. Electronic Data Interchange (EDI) rejection
Invalid information held in the patient’s record will cause claim rejection by EDI.
3. Payer rejections
Rejection in claims occurs according to the insurance guidelines and payer details.
Denials or payments are processed only after these three levels. Medical billing claims follow a secured and encrypted transmission process.
8. Accounts Receivable Calling
AR caller concentrates on lower denials and increases payment flow in Revenue Cycle Management.
They are timely follow up with insurance company increases payment receivables in the medical billing process. AR caller’s main focus is to ensure payment posting for the services rendered by healthcare providers.
They hold responsible for sharing accurate details or information about the patient and rectify if any errors are found. Correspondence and return mails from insurance and patient.
9. Denial Management
Denial management is an important key factor in Revenue Cycle Management. It motivates profitable revenue growth by reducing the denials with the insurance company.
Addressing the denied claims on various issues and maintaining constant follow-up. Taking appropriate actions to decrease denials and increase revenue payments.
Determine the causes for denials and reduce the risk of future denials. Each denied claim is analyzed and researched by the denial management team for the best course of action.
Quicker payments for the denied claims within a short period. Prioritize denied claims based on payer, amount, and others to ensure maximum reimbursements.
10. Payment Posting
In the process of payment posting, after the adjudication of the claim from the insurance providers, the claim will be either paid or denied and a document called EOB/ EOR (Explanation of Benefits/Explanation of Review), will be sent to the healthcare provider and insured.
EOB contains the following information
- Name of the patient
- Payer name and address
- Provider Name and address
- Member ID
- Claim received to date and denial date
- Date of Service (DOS)
- CPT Code
- Billed Amount and Claim Number
If a claim is processed successfully, then a check will be provided, or EFT (Electronic Fund Transfer) will be done to the healthcare provider from the payer along with the EOB.
Most importantly, the medical claim will be paid to the provider only if the patient has signed the Assignment of Benefits (AOB) documents. If the patient has not signed the AOB, then the payment will directly go to the patient.
Here the main role of the payment posting team is to ensure frequent posting to the patients without any denials.
The process of medical billing and coding consumes the valuable time of the healthcare providers which can be used for delivering quality care to patients.
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