An elaborate series of steps that ensure medical professionals are reimbursed for their medical services to the patient is known as medical billing. It typically deals with legal as well as administrative aspects of the medical industry. To be more precise, medical billers provide budget-friendly medical plans to patients while ensuring that healthcare professionals are reimbursed appropriately for their services. Hence, a medical biller ensures a healthy bridge between patients and medical professionals. Since Medical billing essentially deals with the financial department of the healthcare sector; it is considered a crucial part of the medical sector. Medical billing offers plenty of job offers for people who wish to associate with the healthcare sector. However, before choosing this field, it is important to understand “ what is medical billing and the steps involved in this process.
The Medical Billing Process:
In short, the essential steps of the medical billing process include registering patient details, medical coding, insurance certification and charge capture. These steps are crucial to generate a medical claim, which is submitted to insurance companies who make sure the healthcare providers are reimbursed properly. Also, it is the job of medical billers to persistently follow insurance companies to ensure timely reimbursements. Since you briefly understood “ what is Medical Billing and why is too crucial, let’s get into the details of the process.
Steps involved in medical billing
The medical billing process follows the below-mentioned steps:
- Registration of Patient:
It is one of the crucial steps of the medical billing process that ensures accurate billing and reimbursement. Patient registration involves collecting personal data of patients, which includes details like name, age, address, insurance details and medical history. It makes sure that patient details are appropriately linked to the services provided to ensure accurate coding and billing.
- Charge Capture:
This process involves precisely documenting the services provided to the patient. This includes diagnostic codes along with treatment codes. Since this process covers crucial details like the type and quantity of services provided along with associated charges, it ensures accurate reimbursement to the healthcare providers.
- Translating diagnoses, treatments and procedures into codes:
After the patient checks out, his/her medical report is sent to the medical coder, who converts the report to an accurate, understandable code. Essentially, the report also includes the patient’s demographic details and this is referred to as superbill. The superbill covers details such as the physician’s name, patient name, medical history, diagnoses, treatments and procedures performed. The superbill is crucial to creating a medical claim. Once, the superbill is created it is transferred to the medical biller through a software program.
- Submitting the claim:
This stage involves submitting a medical claim along with other codes and charge information regarding the patient. To ensure reimbursements on time, it is essential to submit the medical claims accurately and completely.
- Verification of Insurance Information:
Essentially, verification is done to confirm the benefits and coverage of patients’ insurance. Insurance verification reduces the possibility of uncompensated care while making sure patients are aware of their financial responsibility.
- Pre-certification and Authorization:
This process is done to get approvals from insurance companies before proceeding with treatments and procedures. For instance, authorization is required before performing surgery or an imaging test. This process is essential to reduce the risk of denied claims.
- Recording Payments:
This process involves recording details like date of payment, mode of payment, and amount paid. This process is essential to ensure that the healthcare practitioner has a proper record of financial performance.
- Billing Report Generation:
The billing report generation process involves making reports on financial performance, and billing along with performance metrics and analysis. This entails generating reports on revenues, expenses, and denial rates in addition to generating reports for management and stakeholders. Generating billing reports is necessary to provide information for Medical Training providers that will help them make informed decisions.
- Compliance:
This step of the medical billing process ensures that all the billing practices follow applicable regulations including HIPPA and state and federal laws. This step involves protecting the patient information while ensuring the medical claims are submitted as per the regulations.
- Follow up:
The final step in the medical billing process ensure the payment is done fairly and appropriately. It is the responsibility of a medical biller to check if patients are making payments on time. In case there is any due from then, the biller must do a thorough follow-up for the payment. The follow-up protocol involves directly contacting the patient and sending follow-up bills.
These steps involved in the medical billing process provide the readers with an in-depth understanding of “ what is medical billing” and the steps involved in it.
Medical Billing Course:
Although many platforms provide a medical billing course, Kodakco is one of the best-trusted platforms as it provides world-class faculty and top-notch content. It started in 2013 to provide education and advisory services to individuals as well as organisations. Currently, their portfolio includes 800 course programs in 27 different categories. It is one of the best programs offered by Kodakco.
In addition to helping you understand “what is the medical billing process in detail”, they also help you know everything about the insurance industry. Furthermore, they explain different methodologies used for reimbursement. Most importantly, their course helps you understand the healthcare industry from a different perspective. Furthermore, they also teach about coding literature such as HCPCS, ICD-10, and CPT. Therefore without further delay enrol with Kodakco to learn about “ what is medical billing” in detail.
Conclusion:
Before pursuing a career in medical billing, it is essential to the process in detail. Although I have given my best to explain “ what is medical and the steps involved, it is always best to enrol in a Medical Course to practically understand the process.
