Medical insurance billing includes several processes. All these processes are vital and need to be accurate in order to process a medical claim efficiently and derive the desired results for the healthcare provider. In this article, we’ll discuss the processes involved in medical billing and how medical insurance billing can be a real support with your practice.

Processes involved in Medical insurance billing

As you might probably know, medical insurance billing starts with the doctor’s office, when a patient visits the doctor and explains his/her problems. Now, before the patient actually sees the doctor, he/she will have to hand over a copy of his insurance card at the front office, so that the details of the patient may be found for billing purposes. The doctor then sees the patient, performs diagnoses and renders him treatment for the particular disease or symptom. The information collected from the front office, along with the super-bill and encounter sheets are then forwarded to the medical billing company to initiate the process of billing.

Scanning- The first step in medical insurance billing

As I already mentioned, the information collected from the patient along with the encounter forms are forwarded to the medical billing company. This process is known as scanning. The data is usually transmitted through FTP, where the billing company accesses the FTP and downloads it. Daily reports are sent at the end of each day on the statuses of downloaded data, pending data and such.

Entering Patient demographics in medical insurance billing

Patient demographics includes all information of the patient- demographic information of the patient, such as the patient name, insurance ID no., Date of birth, etc. All these are recorded in a demographic software by a data entry team, as the second step in medical insurance billing.

Medical Coding and Charge Entry

Medical coding is one of the most crucial processes that is included in medical insurance billing. Here the medical coder assigns appropriate CPTs and ICD codes to the procedure and diagnoses pertaining to the patient.

After assigning appropriate medical codes, the super-bills are handed over to the charge entry team, who in turn generates the bill for the services rendered by the healthcare provider. The billed amount depends on the CPT code entered by the medical coder.

Transmission of medical claims and AR follow-up

Finally, the claims are forwarded to the insurance company for processing payment. Once the insurance company makes the payment, a team of cash posters enters the payment details into another software based on an EOB (Explanation of Benefits), send along with the cheque or payment. Denied benefits and rejected claims are then followed up by the AR team, which consists of an efficient workforce specialized in acquiring payment from insurance companies.

So, I guess that’s pretty much it about the processes involved in medical insurance billing. Thank you for reading and have a nice day!