Hcr 220 Medical Billing Process Research Paper

Medical Billing Process
Brittany Campbell
HCR/220
September 1, 2013
Lydia Cavieux There are ten steps included in the billing process and are used to help process the patient’s information from preregistration to the follow up payments. Each patient has the responsibility to pay for their services once they have received care from a facility by themselves or an insurance company. Many different health insurance companies that may help an individual cover their medical expenses or even pay the entire bill. This billing process is usually done in the back office whereas the registration and collection of information is done in the front office. The first step is the preregistration of the patient and this step is used to get an idea
of why the patient is seen. It also gives the office an idea of what the appointment will include. During this time an appointment is scheduled for new patient and previous patient’s information is updated. Establishing financial responsibility is the second step which involved a series of questions used to identify the financial responsibility for the visit. The facility needs to know if the patient will be paying for it themselves or if they are insured and if they are to be able to determine their coverage plan. Many facilities offer payment plans to those who are not covered. The third step is checking the patients in, first time patients will need to fill out a complete history and current contact information whereas previous patients just need to look over and update their information. Important forms are filled out, copies of any cards are taken, and any co-pays are paid during this time. Once a patient has been diagnosed and procedures have been followed they are coded by a medical coder to verify the codes with the information found in the patient’s medical record.
This is step four, reviewing coding compliance, which makes sure that all guidelines are followed while the codes are assigned. A diagnosis and procedure code are used in the patient’s account and entered in the patient ledger that updates their account information. Step five takes us to review the billing compliance; there are many types of fees for the services provided by a facility. Medical insurance specialists help by determining what a patient needs billed to them and what the insurance company should pay for. Checking out the patient comes next in the steps of bill processing. The payments for the patient visit are taken care of in this step while the patient is still in the office. The codes are completed, the balance has been figured, and now the charges are discussed with the patient. After everything is paid or billed, follow-up work is scheduled, and the patient is finished in the
office. Now the office visit is complete, we move on to the seventh step that prepares and transmits the claims.
Because this is an important step, many facilities use a professional to prepare the claims and send them out. A claim contains a patient’s diagnosis, treatment, and charges to the coverage company. These claims need to be extremely accurate and filed on time. Monitoring the payer adjudication is step eight, it helps the coverage companies decide if they should pay the full claim, part of the claim, hold off until further information is obtained, or denied completely. After the decision is made, a letter is sent back to the facility and a specialist makes sure that all the payments are accounted for and the reasons for denial are given. Many times the coverage company does not pay the full amount and here is where step nine comes in. What the company will pay is deducted from the patient’s bill and the final bill is given to or sent out to the patient to pay their
bill. The final step is the follow up payment and collections. This occurs when a patient does not pay their bill or are late making a payment; a collection is sent out to remind them in an attempt to receive payment. Through chapter one I have found that the billing cycle is much more complex than I had originally thought. I found the main focus of the billing cycle is for all of the information to be gathered and processed as quickly and accurately as possible.
References
Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2013). Medical Insurance: An Integrated Claims Process Approach (6th ed.). Retrieved from The University of Phoenix eBook Collection database.