medical billing cycle steps

Keep an eye on commonly missed charges, such as supplies, devices, injections, infusions, vaccines (administrations), venipuncture, and whether the patient is new versus established, Daily advised. Quickly identify when codes/charges are missing or there is an error in code selection. Small charges often missed quickly add up to thousands of dollars.

Oh, and don’t worry, they won’t finish this process at lightning speed. It can take a while for the insurance companies to make a decision. They’ll review the documentation, compare it with the patient’s coverage, and maybe even consult a magic crystal ball to predict the outcome. Medical coding involves analyzing clinical documentation and linking each service, medication and procedure with its designated code. Those codes, recognized within a standardized coding system, synthesize what providers did during a patient visit. While certain aspects of medical billing and coding overlap, they’re not identical tasks.

Understanding the Importance of HIPAA Compliance in Medical Billing Software

The biller reviews this report in order to make sure all procedures listed on the initial claim are accounted for in the report. They will also check to make sure the codes listed on the payer’s report match those of the initial claim. Finally, the biller will check to make medical billing process sure the fees in the report are accurate with regard to the contract between the payer and the provider. Once the payer adjudication is complete, the payer will send a report to the provider/biller, detailing what and how much of the claim they are willing to pay and why.

medical billing cycle steps

Run these reports by the DOS rather than the date of post, Daily said. Use the reports as staff learning tools, set up goals, and make staff accountable to fix errors hurting your practice’s revenue cycle. Beyond basic demographic information, this step is all about gathering patients’ health and wellness history. For example, you may inquire about patients’ smoking status, pain level, and how many times they’ve fallen in the last year. Patients may also review and edit a printed medication list before each visit. You’ll also want to collect records from other doctors if necessary.

Record Patient Information During Visit

But don’t delay because there is a limited time in which you can submit a corrected claim. Payment posting not only involves of posting payments but also consists of posting adjustments, forwarding balance to secondary or tertiary payer, billing patients and posting denials. A Superbill is used by Charge entry team as a primary source of data for creating claims. These claims will eventually be verified for accuracy, compliance and submitted to insurance company for reimbursement.

  • Make sure the reason for the visit is clear, any diagnoses are included, prescriptions listed, and so on.
  • Regular training for staff can also help ensure accurate data collection.
  • Technology like electronic health records (EHR), patient portals, and virtual communication can not only improve your RCM, but can also help boost patient engagement and retention.
  • Medical practices should have a credentialing specialist to handle these tasks.
  • Lack of communication, delayed responses, or disputes can prolong the accounts receivable cycle.