Guide to a Successful Medical Billing Process

Guide to a Successful Medical Billing Process

Medical billing is complicated. A smooth medical billing process, however, is necessary to ensure your medical practice runs smoothly, too. As the owner of a medical practice, you need insurance claims to get approved and the funds to funnel back into your bank account as soon as possible. If you follow this guide – and only work with experts in the medical billing field – you have nothing to worry about.

Medical Billing Process for Smooth PaymentStep One: Patient Check-In

It is vital to the billing process for your patients to check in before every appointment. This is when your practice notes the patient’s personal information and his or her insurance. If this is a returning patient, you will already have this information on file. However, you still need to have the patient check in to confirm none of the information has changed.

Step Two: Insurance

Request that your patients bring insurance information to every single appointment. This is the easiest way to confirm their insurance is still active and providing coverage. Insurance information changes at the drop of the hat, so it is best to confirm this information during check-in before every appointment. If your patient did not bring insurance information, reschedule the appointment and tell him or her to bring their insurance details next time.

Step Three: Diagnosis, Procedure, and Modifier Coding

When it comes to medical billing, using the proper codes is vital to timely insurance claims. The codes tell the insurance provider what the patient has, what the treatment is, and any medical equipment used during the treatment or testing process. Never rush, and make sure all your staff members understanding the coding system.

The reason using the wrong code is a problem is that you submit the claim to the insurance provider. Imagine it takes two weeks for the insurance provider to improve or deny the claim. If you used the wrong code, the provider denies the claim, and you must refile the claim in two weeks. Then, you wait another two weeks for the approval. So, four weeks later, you receive payment from the insurance provider for the treatment you filed a claim for.

Step Four: Claim Submission

Once you finish filling out the insurance claim, you submit it to the insurance provider to receive payment for the treatment rendered. It is important to make sure you properly fill out the insurance claim and include all details the insurance provider requires regarding the appointment, diagnosis, and treatment plan. Not following the insurance provider’s guidelines will result in a denied claim, requiring you to start the process over again.

Step Five: Payment Posted

Once the insurance provider approves the claim, the provider posts the payment to your medical practice. The bill will reflect $0 if the insurance provider covers the entire treatment. Otherwise, the remainder of the bill becomes the responsibility of the patient. Then, it is your responsibility to reach out to the patient about paying the rest of the bill.

It is in your practice’s best interest to have a collection agency in place for situations where the patient refuses to pay the bill – or cannot pay the bill. A collection agency buys the debt from you and pursues the patient to obtain the debt – with interest – on its own terms.

As long as you follow these five steps, the billing process of your medical practice will run smoothly.

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