A Step-By-Step Guide to Medial Billing in 2021

Last Updated: February 16, 2021

Medical billing and coding are an essential part of healthcare organizations to handle their processes efficiently. Organizations use specific tools and electronic health records (EHR) systems to automate several medical-billing processes, such as coding and recording insurance, etc., from interpreting doctors’ notes to ensuring billing standards. Medical billing is a complex endeavor to help doctors operate a successful medical practice.

Don’t be Scared of Medical-Billing, Make it Simple Instead

The process of revenue cycle management, coding, and billing is complex. However, there is no need to feel overwhelmed; let us provide you a step-by-step guide to medical billing and coding to save you frustration and hassle.

  1. Patient Registration
  2. Evaluation of Patients’ Finances
  3. Check-in and Out Procedures
  4. Verification of Compliance
  5. Claims Submission and Paying Decisions
  6. Managing Payments

So, let’s get started.

Patient Registration

A doctor’s office registers the patient first as they receive their appointment request. For the first-time patient, the information is recorded by creating a new record. The patient has to provide a reason for the visit. The patient also provides an identification form to the healthcare provider to start the medical-billing procedure.

Evaluation of Patients’ Finances

The medical-billing service is responsible for evaluating the financial situation of patients. They need to check patient’s insurance coverage and plans before their appointment. Since not all plans offer complete medical coverage, the front office must inform the patient about the services they are eligible for. Hence, patients may require paying more expenses than usual.

Check-in and Out Procedures

As soon as the patient arrives, the check-in starts until he leaves and checks out. A payment kiosk is a useful device to perform these tasks to maintain patient attendance. At the time of service, co-payments are made by the patients. After the visit, the patient report is then sent to the billing company to analyze or review to accurately transform the data into codes.

Verification of Compliance

The medical-billing software completed dozens of tasks, including detailed information about verifying compliance. The medical biller, then, creates a medical claim; they ensure that the claims meet all the compliance standards. That involves reviewing the codes to ensure that all the medical procedures are coded accurately. In accordance with the patient’s payment plan, the billing officer verifies whether the procedure is billable.

Medical-billing companies use Health Insurance Portability and Accountability Act HIPPA Act (1996) to ensure medical bills’ legitimacy. Therefore, HIPPA compliance is essential to make sure that the bill meets all standards of billing.

Claims Submission and Paying Decisions

The HIPPA Act also ensures that healthcare companies must prepare medical claims electronically. Some medical-billing firms also use manual claims that are not free from errors; that may waste ample time of payers. With the medical-billing electronic process, you can save significant time and eliminate human mistakes.

Moreover, medical officers send their claims to clearinghouses that then send those claims to the payers. The medical-billing process can lower the stress for payers and doctors by taking the hassle of reformatting different claims.

Managing Payments

The final and most crucial step in the medical-billing is to ensure the payment of all medical claims. Medical billers also process and promptly sending accurate medical claims. However, they also work hard to remain in touch with the payers who make late payments. Once the patients pay the claims, the billers can record or save the information in their records.

Besides, if a patient fails to pay the bill, the medical-billing officer also notifies the medical service provider to get a full refund for their services. Therefore, follow-up processes with doctors and patients are integral parts of billers’ tasks.

The Bottom Line

The logic suggests that there is no need for medical professionals and healthcare companies to take all the hassle of medical-billing and coding. The best strategy is to outsource the medical- billing procedure to an expert organization that hires serious professionals to streamline all doctor-patient records and ensure compliance with HIPPA standards.

Medical-billing is becoming more popular to get more accurate and robust results.


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