Understanding the Medical Billing Process: Step-by-Step

Healthcare providers may find the medical billing process aggravating. Manual errors and denials leave healthcare providers in a constant spiral. Ensuring a process free from inaccuracies can become a hassle.??

Efficient medical billing is essential and handling the steps in medical billing properly can help healthcare providers in achieving that.??

In this blog, we will learn about the six vital steps in the process of medical billing. We will also understand how using these steps can change a healthcare practice’s bottom line.??

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Key Steps in the Medical Billing Process Explained?

Maintaining revenue cycle management and operational flow in check is attainable. With consistency in these steps, healthcare providers can realize their financial goals.??

The following are the steps in medical billing:?

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Patient Registration??

Registration happens at the time of patient check-in. This is the first step in the medical billing process and the initiating point of errors. During a patient's appointment, vital demographic information must be recorded accurately. This patient data is later used at the time of coding.??

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Insurance Eligibility Verification??

The next step is insurance eligibility verification. Healthcare providers must check the eligibility of every patient’s insurance policy. This is essential to check policy coverage and authorizations before rendering healthcare services to patients. This is the best time to determine any changes in the insurance policy for both patients and healthcare providers.??

Missing vital details during verification can hamper the medical billing process and lead to denial of claims.??

Medical Coding??

After the patient has received treatment, comes the time for medical coding. This step simply means translating rendered services into accurate codes to file claims. All diagnoses, treatments and procedures are converted to relevant codes.??

The complexity of coding depends on the specialty and the chances of errors in coding are also higher. Healthcare practices need coding expertise to handle this step and maintain accuracy. Also, the codes must be CPT, HCPCS, ICD-10, and modifiers depending on the specialty.??

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Charge Entry??

After medical coding, the next step is ‘charge entry’ which means entering healthcare charges for rendered services. At this step, it is essential to link accurate medical codes with treatments provided to patients.?

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Claim Submission??

Then comes claim submission which is one of the final steps in the medical billing process. The filed claims must be submitted at the right time to prevent denials caused by delays. The time of submission is decided by the insurance companies and a failure to meet deadlines can lead to revenue leakage.?

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Payment Posting??

The last step is payment posting, which happens after the healthcare providers have received revenue. It is the insurance payer’s responsibility to notify healthcare providers about the payment and reflect that status to the patient as well.???

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Bottom Line??

These basic steps are essential to streamline the administrative task and optimize the bottom line. Other than this healthcare providers must also ensure crucial factors such as denial management and follow-up.?

If healthcare providers improve the medical billing process, they can maximize their revenue and upgrade operational management. On the other hand, if healthcare providers struggle to keep up with the dynamic medical billing environment, they can choose outsourcing.??

Taking effective measures can improve medical billing and revenue cycle management!?