Physician billing services or medical billing is a quite complex and complicated procedure. It is a streamlined process that runs smoothly according to a predefined plan. There are a fixed number of steps that result in a complete transition of the procedure. This drastically embeds efficacy in the claim submission process and optimize collection management. Although, it might seem convenient but the reality contrasts with the inception. Therefore, most people want to be part of the medical billing profession without any specification, but most of the industries demand certified experts for medical billing tasks. Following is the complete anatomy of the medical billing system.
Medical billing is initiated as soon as the patient check-in the health-care faculty i.e. physician’s office, hospitals or clinics. The staff collects information about the patient’s visit and preregister their information. The patient provides information about his/her insurance payer, plan number and adequate information about their claim. All of this detail is collected and recorded at their check-in.
Insurance Eligibility and Verification:
Every patient must verify the eligibility criteria for his/her insurance policy. Insurance information can be modified anytime, according to the change in the regulations or policies of HIPAA. A patient must stay up-to-date with their insurance policy every time they visit their physician. A change in an insurance policy can also impact benefit and authorization information, so it is always important to verify the insurance plan to get rid of trouble of double-checking.
Medical Coding of Diagnosis, Procedures and Modifiers:
Medical coding is the procedure of translating health care diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are extracted from the documentation of medical records i.e. such as doctor’s prescription, laboratory and radiologic results, etc. Medical coding professionals help to ensure that the codes are implemented correctly, they are verified to remove errors during the medical billing process, and otherwise, it might result in claim denial. During medical coding preparation, the information from documentation is abstracted, converted into suitable codes, and producing a claim to be paid by insurance carriers.
Medical coding procedure is executed every time you visit a healthcare provider. The healthcare provider goes through your complaint and medical history, makes an expert assessment of the treatment to be delivered, and documents the information of your visit to the health care faculty. That documentation is not only the patient’s ongoing record, it is also the source of the payment for physicians.
In this step the charges of health care services received are mentioned as an entry. The charge entry also includes the appropriate proportionality of medical codes to services and procedures that are rendered during the patient’s visit.
Once the claim has been properly submitted, it must be received and accepted by the insurance payer for payment. Medical billers require access to the information of payers since there are so many variables for each insurance payer to determine the terminal of the claim submission process.
While most insurance companies follow a standard set of rules for medical billing, but some payers have different standards for payment. There are certain aspects of medical billing that depend upon the payer’s policies, so it is important to verify each payer to ensure that you are accurately following the guidelines of payers for claims submission.
This step comprises of posting and deposit functions. At this point, the patient won’t be billed with any amount, as it is claimed to the third-party payers. The insurance payer’s responsibility should comply with the accomplishment of this last step.
See also – :