Capstone Individual
Capstone Individual
HCR/220
Lylita Brown
Maryam Lyon
May 7, 2015
The medical billing process consists of ten steps that can be categorized into three main groups that break down how the Health Insurance Portability and Accountability Act (HIPAA), International Classification of Diseases (ICD), CPT, and HCPCS influence each of the ten steps. The main groups are: pre-registrations, claims preparation process, and finalizing the claims processes.
Pre-registration involves the patient’s initial visit. This is process where the patient is advised of their rights and given all disclosures and privacy information pertaining to that of HIPPA privacy act. Along with the written disclosures and policies any financial obligations such as copays are discussed according to that of the HIPPA regulations. The steps here builds a level of comfort for new and established patients and ensures their longevity with the company.
The claims preparation process is where the ICD, CPT, and HCPS codes and billing are incorporated and utilized based off that of the patient’s insurance coverage and the proper billing and coding procedures. This process touches on billing compliance standards and ensures that it is all done correctly resulting in no error claims submissions and charges to the insurance companies. This step is very important to any medical office because it provides efficiency. The last category is finalizing the claims processes. Here is where the claims are prepared for submission and we come full circle back to HIPPA regulations. The involvement of patient statements and payments, collection of amounts owed, and financial adjustments (if need be) all takes place in this group. The collection of payments and the collecting of all information pertaining to payments should be followed and strictly enforced according to the privacy act. Looking over the three main groups it shows how they all work together cohesively to provide the patient care and office function all
HCR/220
Lylita Brown
Maryam Lyon
May 7, 2015
The medical billing process consists of ten steps that can be categorized into three main groups that break down how the Health Insurance Portability and Accountability Act (HIPAA), International Classification of Diseases (ICD), CPT, and HCPCS influence each of the ten steps. The main groups are: pre-registrations, claims preparation process, and finalizing the claims processes.
Pre-registration involves the patient’s initial visit. This is process where the patient is advised of their rights and given all disclosures and privacy information pertaining to that of HIPPA privacy act. Along with the written disclosures and policies any financial obligations such as copays are discussed according to that of the HIPPA regulations. The steps here builds a level of comfort for new and established patients and ensures their longevity with the company.
The claims preparation process is where the ICD, CPT, and HCPS codes and billing are incorporated and utilized based off that of the patient’s insurance coverage and the proper billing and coding procedures. This process touches on billing compliance standards and ensures that it is all done correctly resulting in no error claims submissions and charges to the insurance companies. This step is very important to any medical office because it provides efficiency. The last category is finalizing the claims processes. Here is where the claims are prepared for submission and we come full circle back to HIPPA regulations. The involvement of patient statements and payments, collection of amounts owed, and financial adjustments (if need be) all takes place in this group. The collection of payments and the collecting of all information pertaining to payments should be followed and strictly enforced according to the privacy act. Looking over the three main groups it shows how they all work together cohesively to provide the patient care and office function all