The Medical Billing Process

The medical billing process consists of creating and processing patient statements and explanations of benefits. The billing process may also involve initiating collection efforts. When a claim is processed but is later rejected by the payer, the process is known as claim denial. There are five primary reasons for claim denial, and most are preventable. In addition, nearly half of claims can be successfully resubmitted when they are corrected.

 

The first step in the medical billing process involves patient registration. At this step, medical billers collect basic patient information such as age, name, and insurance information. This information is crucial for verifying eligibility and receiving prior authorization. Once a patient registers with a billing office, their information is entered into a patient file. Visit this link: https://www.coronishealth.com/fqhc-chc-clinics/ for more info about the medical billing process.

 

In the second step, charge entry, the patient's medical records are reviewed. A dollar amount is assigned to each record. This document then goes through the insurance company's review process. The medical biller notates any errors found in the claim. Once a claim is approved, it goes to the insurer for payment.

 

Medical billers must obtain patient insurance information, including deductibles and copayments. They must also explain to patients what each charge on their bills means. Sometimes, patients are confused and don't understand the information on their bills. In these cases, medical billers must explain the difference between copayments and deductibles.

 

Medical billers must also be computer literate and have excellent communication skills. They must be accurate and courteous, and they will have to deal with insurance companies and patients on a daily basis. They must be able to work independently and with a team. A medical biller's role is critical to the health care industry.

 

Another task that medical billing staff must perform is understanding the complexity of insurance plans and the laws and regulations surrounding medical billing. A large insurance company can have as many as fifteen different insurance plans contracted with a single provider. Providers must accept each insurance plan in order to receive payment. This requires specific knowledge of each insurer's rules, fees, and timeframes for filing claims.

 

The first step in the process is understanding the types of forms used by the insurance companies. Medical billers must understand how to fill out the fields on the forms and adhere to HIPAA claim standards. Some practices use clearinghouse software to submit medical claims to insurers. Clearinghouses provide an array of services to help medical practices manage their revenue cycle. These clearinghouses review the claims for accuracy and compliance with the policies and regulations of the payer. If corrections are needed, they will send the corrected claim to the payer. You can get more info about the medical billing process on this page.

 

Training is an essential part of any medical billing career. A high school diploma is necessary for many jobs, but many employers will prefer a college degree or certification in this field. Training can be obtained through on-the-job training, certificate programs, associate degree programs, or Web-based courses. Many community colleges offer certificate programs in medical billing. Typically, these programs last two to three semesters and cover the basics of medical terminology, accounting, and basic anatomy and physiology. Afterward, graduates may take the AHIMA credentialing examination. Education is a never ending process, so continue reading here: https://en.wikipedia.org/wiki/Medical_billing.