As a healthcare provider, you are undoubtedly aware of the importance of getting paid for the services you provide. After all, your practice would quickly become unsustainable without proper medical billing.
Fortunately, there is a process that can help ensure you get paid what you deserve. Here is everything you need to know about the medical billing process.
What is Medical Billing?
Medical billing is submitting claims to insurance companies and other payers for reimbursement for the services you have provided. This typically includes preparing and submitting invoices, following up on unpaid claims, and managing denials.
The medical billing process can be complex and time-consuming, but it is crucial to the financial health of your practice.
What Are the Steps in the Medical Billing Process?
There are a few key steps in the medical billing process, which we will outline below.
1. Collecting patient information
The first step is to collect all necessary patient information, including insurance information, demographics, and financial information. This can be done at the time of service or prior to service.
One aspect of medical billing training is instruction on properly documenting a patient’s information. One can only imagine the confusion if even one key element, like age, race, or name spelling, was wrong. For this reason, it pays to double-check the provided information. This is generally personal info such as contacts, current insurance card, and medical history or reports.
The healthcare field can only continue to function if the professionals and institutions are paid fully. Consequently, bills have to be invoiced and resolved in a timely fashion, making the proper acquisition of insurance information imperative. Such info is often submitted by the patient to be verified so that the services covered by the insurance company can be determined. Coverage data is often obtained following a call or fax to the insurance company. If the insurance provider won’t cover the required medical costs, the biller makes the patient aware that they will have to pay the entire bill.
Patient check-in and check out
For the convenience of both the patient and providers, people coming in for treatment have to fill out forms that give adequate information regarding current health problems. This aspect is part of the registration process previously mentioned. If it isn’t their first time at the doctor’s office or facility, the patient is asked to provide a driver’s license or passport and a valid insurance card to verify identity.
If and when the information checks out, the doctor sends the medical records to the medical coder.
2. Coding Services
Once all the necessary information is collected, the services provided will be coded using ICD-10 codes. These codes describe the diagnosis, procedures, and other services performed.
The medical coder analyzes and translates all inputted information into accurate medical codes, like patients’ diseases, symptoms, and medical procedures in the medical report. Now, the coder biller may receive this information in various ways. One is via audiotape, where a specific type of biller, called a transcriptionist, will transform the data into word documentation. The other is via medical forms, which go straight to the biller to be coded and filed. Accuracy is key here, so intensive study is needed for the position.
Checking code compliance
Here, medical codes are cross-checked to ensure no errors when entering them. As a result, many billers and coders have to be more than a little aware of the basic guidelines of compliance. Coders will also look out for the potential of fraud or abuse, which healthcare workers themselves often perpetrate.
3. Submitting claims
After coding the services, claims are submitted to insurance companies and other payers. Claims can be submitted electronically or by paper.
Preparing and transmitting claims
Another aspect where training becomes super important is in the area of claims transmission. At this juncture, the medical coder prepares a superbill, i.e., a medical document containing the patient’s name, physician, procedures performed, code for diagnosis, and other important medical information. The medical coder then transfers the superbill to the medical biller. The biller puts the superbill either in a paper claim form or billing software. The superbill then awaits perusal from an auditor.
Auditing a claim
A billing auditor checks the document for errors and fixes any identified mistakes. While this process can include innocuous issues like typos, it may also look out for malpractice concerns like irregular billing or overinflated pricing. Essentially, the auditing process becomes a kind of a double-check after the compliance assessment.
Once checked, rechecked, and triple checked, the medical biller can either send the claims to the insurance companies directly or via a clearinghouse. Once it leaves this stage, the superbill becomes the insurance company’s property. They will assess it for claim viability.
4. Following up on claims
Once claims have been submitted, a follow up is needed to ensure that they have been received and processed. This may involve calling the insurance company or checking online portals.
5. Managing denials
Unfortunately, not all claims will be paid. When this happens, you will need to manage the denial, which may involve resubmitting the claim with additional information or appealing the decision.
While many claims are approved and processed speedily, others may be delayed or rejected. Delays and rejections often occur for one or two reasons. The payer carefully reviews all the received documents to assess the quality of the claim. If there are errors or missing information, the payer sends the document back to the medical biller for correction. The payer can also fail to make the payment if the claim doesn’t comply with what the patient and the company agreed upon.6.
6. Collecting payments from payers and patients
The payment made by the insurance payer is received. The biller verifies it is the right amount and then updates the patient’s account. If the amount received isn’t correct, the biller contacts the payer. If the payer denies payment, the medical biller contacts the patient to inform him he is required to pay the remaining balance. Insurance companies don’t pay for services not included in their insurance policies.
In any case, most patients are aware of what they do or do not have access to via their insurance, so claims are readily handled and resolved by and large. When a conflict does arise, patients may or may not have recourse in this regard. No matter the outcome, the medical biller is there to streamline a process that assists both patient and doctor in their ongoing pursuit of wellness.
Medical Billing Services FAQs
1. What is the difference between medical billing and coding?
Medical billing and coding are two separate but related processes. Medical billing involves submitting claims to insurance companies and other payers, while medical coding involves assigning codes to diagnoses, procedures, and other services.
2. Do I need a medical billing service?
There is no one-size-fits-all answer to this question. Some practices choose to outsource their medical billing to third-party services, while others handle billing in-house.
The decision to outsource medical billing can be a difficult one. Ultimately, it depends on your practice’s capacity, needs, and budget.
Outsourcing medical billing can be beneficial for practices that do not have the time or resources to handle billing in-house. Third-party services can help streamline the billing process and ensure that claims are submitted and processed accurately and efficiently.
Ultimately, the decision to outsource medical billing depends on your practice’s specific needs and budget.
3. How much does a medical billing service cost?
It could be in the form of monthly fees, a one-time payment, or a combination of the two. Administrative fees, set-up fees, training, licensing, and other expenses may be included. Check out this blog post for more information on the cost of medical billing services.
4. What are the benefits of using a medical billing service?
A few key benefits to using a medical billing service include increased efficiency, accuracy, and flexibility.
Outsourcing your medical billing can be an excellent decision for your practice, as it can provide a number of benefits, including:
A medical billing service can help increase your practice’s efficiency by handling all of the billing and follow-up tasks for you. This can allow you to focus on providing quality care to your patients.
By outsourcing your billing, you can ensure that all claims are submitted accurately and less chance for error.
A medical billing service can be flexible to meet the needs of your practice. They can work with you to create a billing schedule that meets your needs and helps to minimize disruption to your workflow.
A medical billing service typically charge a percentage of the claims they process, so you can save money by outsourcing your billing.
Overall, outsourcing your medical billing can be a wise decision for your practice. It can help to improve efficiency, accuracy, and flexibility while also saving you money in the process.
What Are the Challenges of Medical Billing?
While the medical billing process is designed to help healthcare providers get paid for their services, some challenges can arise. These challenges include:
1. Insurance companies changing their policies: One of the biggest challenges in medical billing is that insurance companies are constantly changing their policies. This can make it difficult to keep up with the latest requirements and may result in claims being denied.
2. The complexity of the process: The medical billing process can be complex, making it challenging to stay compliant. This is why it is important to work with a medical billing company with experience and expertise in the industry.
3. Denials: As mentioned above, not all claims will be paid. When denials occur, it can be time-consuming and frustrating to manage them.
Overall, the medical billing process is essential to the financial health of your practice. While there are some challenges involved, working with a medical billing company can help to make the process simpler and more efficient.
Improve Your Revenue Cycle Management With Practice With Ease
If you are looking for a medical billing company to help with your revenue cycle management, look no further than Practice with Ease. We are experts in the medical billing industry and can help to streamline your billing process. We offer several services, including:
We will submit your claims to insurance companies and follow up on any denials.
Accounts receivable management
We will manage your accounts receivable and work to collect payments from insurance companies.
If your claim is denied, we will help you file an appeal and get the reimbursement you deserve.
We can help you obtain the credentials you need to participate in insurance plans.
Do you have any questions about the medical billing process? Let us know in the comments below! Contact Practice with Ease today if you are looking for a medical billing company to improve your revenue cycle management. We will work with you to create a customized solution that meets the needs of your practice. Schedule a free consultation today!