Steps in the Medical Billing Process

Steps in the Medical Billing Process

By: Leslie Maxwell

May 26, 2013

HCR 220 Claims Preparation I: Clean Bills of Health

Instructor: Jo Ann Kubica

University of Phoenix / Axia Online College

The Medical Billing Process has 10 steps. The following document will not only list each step but also explain what each one consists of.

Step one: Preregister Patients.

This step requires scheduling appointments, establishing a reason for the visit and collecting current information. New patients will fill out forms that include important personal information, i.e. name, birthday, address, etc. These forms also ask for family history of illness and insurance company information for authorization and billing. Returning patients review their information and update where necessary.

Step two: Establish Financial Responsibility for Visit.

This step is very important. The provider needs to know exactly what services the insurance company will cover, the billing rules of the policy, and what will be paid by the patient. Once the provider has obtained this information they will then confirm the patient eligibility for services, and determine which insurance company, if more than one, will be billed first. Obtain preauthorization for services if needed, and follow the payer’s procedures accurately so there is no delay in payment.

Step three: Check in Patients.

New patients will need to fill out all required forms with pertinent information, while returning patients review and update their information. Photo copies of proper I.D. and insurance cards are made and placed in the patient file. The patients financial responsibility is then stated and collected either prior too, or immediately following the patients encounter with the physician.

Step four: Check out Patients.

During the patient visit the physician the physician documents each procedure and the diagnosis. These procedures each have medical codes for billing...