Steps in the Medical Billing Process
The first part happens before the encounter with the patient, which is step 1, preregister the patient. Initial information is taken from the patient on their demographics, contact information, whom the primary care physician is, and financial information. Also covered are the reason for the visit, and any scheduling and updating of appointments for any other services. The second section is steps 2 – 6, during the encounter. Step 2 is establishing financial responsibility. If the patient is insured, the health plan is examined for services covered, the billing situation, and any copay or coinsurance rules. If the patient has more than one health plan, it must be determined which plan is charged first. If the patient is not insured, he or she is informed of sole responsibility in paying the bill, and presented with any payment options if the bill is high. Step 3 is checking in the patient. If the patient is new, the front office worker collects detailed medical, demographics and contact information. The patient’s insurance card, and if necessary, driver’s license as well, are copied or scanned for the patient’s file. If he or she is a recurring patient, all that is needed is confirmation of insurance, medical, demographics and contact information, and if needed, updated. Step 4 is reviewing coding compliance. Reviewing coding compliance is done by the physician, the medical coder or medical insurance specialist. Each diagnosis is given a diagnosis code as found on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) form, while each procedure is given a procedure code, as found on the Current Procedural Terminology (CPT) form. Some codes group services, like surgery and pathology, and other codes cover supplies and other services. Step 5 is reviewing billing compliance. The medical coder or medical insurance specialist determines what procedures and codes can or cannot be billed...
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