Hcr 220 Steps in the Medical Billing Process

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Assignment: Steps in the Medical Billing Process

The Medical insurance specialist is tasked with gathering and maintaining patient demographics and insurance information, appropriate filing of claims, and processing of payments. To ensure these responsibilities are done in a “maximum, appropriate, and timely payment,” a series of steps are followed.

Step 1 Preregister Patients

Preregistration involves the appropriate scheduling and updating of appointments. New patients calling will be asked for basic demographics and insurance information. Both established and new patients will be asked the reason for the visit so scheduling can be done appropriately.

Step 2 Establish Financial Responsibility for the Visit

To ensure the correct billing of payers, it is imperative to obtain answers to these questions regarding an insured patient; what is the patient’s eligibility status, what services are covered, if more than one health plan, determine which is the primary plan (they will be sent the first claim), meet the conditions of billing rules, and determine the patient’s financial responsibility. This information not only lends to proper billing procedure, but allows the medical insurance specialist to explain to the patient what they will be responsible for. Uninsured patients will be responsible for all services rendered and in some cases a payment plan will be arranged.

Step 3 Checks in Patients

New patients will be asked, at the front desk, to give detailed and complete information regarding their demographics, health plan, and medical history. Insurance cards and any form of ID will be copied and placed in the patient’s file. If a co-payment is required, the correct amount is noted for the patient and may be collect before or after the patients encounter with the physician. Established patients will be asked if there is any change in their demographics information or insurance.

Step 4 Check out Patients

During the patient’s exam or treatment,...