Medical billing is the process of creating healthcare claims to submit to insurance companies to get paid for medical services provided by providers. After the service has been transcribed into a billing claim, the medical billing agency will track the claim to ensure the organization is properly reimbursed for its service.
The Medical Billing Process
One of the primary goals of medical billing is a prompt follow-up. This helps with the cash flow and ensures that no claims slip through the tracks. This can be tricky, though. The medical billing process is riddled with limitations either by organizations or by laws. Most states require insurance companies to pay claims within 30 to 45 days. Errors at any point in the process can be extremely pricey for the organization. There are two main steps in medical billing:
Front-End:
This is what a medical billing organization has to handle before the patient leaves the physician’s office.
- Pre-registration and registration: When a patient contacts a provider’s office to schedule an appointment, the staff will record the patient’s general information and insurance information
- Insurance eligibility verification: After this, the front office staff must confirm that the requested services will be covered by the insurance provider. This step is particularly important for practices outside of the primary care umbrella.
- Encounter form generation: After a patient pays their copay, staff will have to generate a superbill for each ‘case’. Essentially, this is for the record keepers and the physicians to keep track of exactly what services were given to the patient. Oftentimes, these are electronic.
- Checkout: Front-end staff will now make follow-up appointments if necessary and charge the patient if they have not yet. After the patient checks out, the medical records are converted into medical codes.
Back-End:
This part of medical billing no longer involves the patient but is between the medical biller and the insurance company and, sometimes, the physician.
- Charge entry: Charge entry staff is in charge of recording what services and procedures were performed and why. They also must ensure that each record has a diagnosis.
- Claim generation: After all of this, it is finally time to create the claim. Medical billers gather information from the superbill, charges, and revenue codes, which they then send to third-party payers.
- Claim Scrubbing: Claim scrubbing is essentially double-checking to ensure all the right information is on the claim. This is often done by scrubbing software, which third–party medical billing services may have that medical service providers don’t.
- Claims Tracking: Medical billers are not done after the claim is submitted. The status must be tracked daily
- Payment posting: When the healthcare service providers receive their money, it must be recorded. After this, patients must be sent all outstanding balances that weren’t covered by insurance.
- Denial Management: When a payer denies a claim, the billers receive a denial code and an explanation. Then, medical billers will review the denial to check for missing information, create an appeal letter, and refile the claims.
- A/R Collections: The final step in the process is ensuring the patient pays their share. The medical biller will communicate through statements to accelerate the collections and lessen the debt on the servicer’s end.
At WCRS, we handle this process from start to finish with complete coding and billing services so that you can focus on your practice. Contact us for more information at (916) 382-0653.
