Medical Billing Basics

Posted by | Posted in Healthy Lifestyle | Posted on 11-05-2011-05-2008


The medical billing process began with pre-registration of the patient. It was the time to gather personal information, insurance and medical facts about the prospective patient. It’s vital that this info is captured and entered onto the laptop or computer program accurately for future contact with the patient and for successful payment of claims. The use of a registration check list is quite valuable. The revenue cycle as well as the success of the practice depend on the accuracy of this data.

By gathering the patient’s insurance information, we are able to Establish Monetary Responsibility for the go to. This is the second step within the medical billing procedure. Data for instance: the name of the insurance corporation, the name of the insured (not often the patient), form of policy, the ID number along with the phone number for the insurance company are essential pieces of information for successful payment of claims. It truly is important for front end staff to know which insurances corporations the practice participates with and which ones you don’t participate with. Several practices do participate with one particular strategy within an insurance company but not other people. For numerous practices, insurance claims and payments are the bulk of the revenue cycle. It really is the life blood of one’s practice. Collecting every dollar that your practice is entitled to is vital to the financial well being of one’s practice. Obtaining the insurance info prior to your patient arrives for their first appointment allows for verification of eligibility and rewards, obtaining the required referrals and authorization, co pay and deductible data. This info must be accurate. Inaccuracy will lead to rejections or denials and will price your practice money.

Patient check in is the third step within the medical billing process. Most practices will have an Facts sheet and/or Intake packet for the patient to fill out. Once more, we are collecting personal, insurance and medical details required to receive payment for services. It’s a time within the process where it is possible to verify the info that you simply already have and obtain any important information that you simply don’t have. Most practices will have the patient sign an Assignment of Rewards (AOB). The AOB is actually a document that authorizes the practice to treat the patient, authorizes the insurance organization to send payment for such treatment directly to the practice and most importantly, that the responsible party (patient, insured parent or guardian) will likely be responsible for payment to the practice. During patient check in, it really is important to obtain a copy of the insurance ID card. Be positive to copy the front and the back of the card and keep a copy of the card within the patient’s chart. Other common practices are to ask the patient at every pay a visit to if their insurance and co pay info is still the same and to collect the co payment at the time of pay a visit to.

The medical billing process is produced up of a lot of sub-processes. The front end processes, are the processes that happen before the Dr. has seen the patient. They may well seem like minutiae, but my twenty years of experience in healthcare and medical billing and collections have confirmed to me that careful attention to these details are vital to the successful payment of initial time submission claims. Successful claims payments on the initial try must be the goal of every single practice. Failure to navigate the intricate rules of the insurance procedure will lead to rejected, denied or short paid claims. Re-working and resubmitting claims for payment will price your practice time and money in salary, phone expenses and postage. Extra attention to detail at the front end processes will create positive results.

Upon patient checkout, most practices use a superbill or SOAP note. SOAP is an acronym for subjective, objective, assessment and plan. SOAP notes and superbills are encounter forms that list all the procedures that a practice performs. Facts on these encounter forms are patient name, date, the name of the doctor supplying the service and any payment or co-payment information related to the services provided. There is normally space provided for the doctor to make any unique notations or recommendations for further testing. Some forms have a place for the patient signature as well as the doctor/providers signature. Each and every service performed or dispensed must be converted into a CPT or HCPC code. Depending on the specialty of the practice, Modifiers will also be on the type. SOAP notes and superbills ought to also have the most common diagnoses encountered by the practice. Merely put, the diagnosis is the doctor’s opinion based on examination of what is wrong with the patient. Each diagnosis must be converted into an ICD code. Mistakes in assigning correct CPT codes can impact correct payment for services. Mistakes in coding may also result in rejections and denial of claims. Rejections, denials and improper payment result in reworking and resubmission of the claim. Claims follow up for rejections and denials costs a practice time and money. A lot of practices employ a CPC (Certified Professional Coder), a person that has training in assigning the correct code for a given service.

To sum up, a superbill or soap note must be filled out accurately for every patient so that the right charges could be entered for services rendered. It really is vital to your practices’ bottom line that mistakes are minimal as mistakes lead to rejections, denials or improper payments. Rejections, denials and improper payments call for additional man hours and other expenses to fix and resubmit the claim and that translates into additional money spent trying to get paid and less money for the practice.

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