10 Steps in the Process of Medical Billing

1. Patient registration
2. Insurance verification
3. Encounter
4. Medical transcription
5. Medical coding
6. Charge entry
7. Charge transmission
8. AR calling
9. Denial management
10. Payment posting.

Patient Registration:

• For the purpose of processing the claim for medical services, data or information pertaining to insurance verification is submitted in a format.
• RCM firm maintains a close grip on patient records to guarantee correct invoicing.
• Only for the new appointment is the aforementioned process appropriate.
• By preserving the details of past appointments, it gives medical billers the chance to verify the information provided before filing a claim.

Insurance verification:

• The medical billing staff thoroughly validate the patient’s insurance throughout.
• Benefits of the scheme are completely focused on eligibility.
• It clearly states if an insurance claim may be made for the provided services.
• It examines the patient’s obligations, including co-pay, deductible, and out-of-pocket costs, to see if they have accrued.
• If the service is not yet ready to be supplied, prior authorisation from the insurance company is needed for some services.
• To expedite the process, the team employs software to validate the patient’s data.

Encounter:

• When a patient sees a healthcare professional, the specifics of their ailment and the treatment provided are either audio- or video-recorded.
• These details may be written down before the patient or after the consultation.
• It provides clarification regarding the illness and treatments that the doctor had recommended.
• They deliver the file to the RCM business so that it may handle medical billing and submit a revenue claim.

Medical Transcription:

• An audio or video recording is converted into a medical script. The script includes the entire health record’s condition.
• Medical transcription is the process of transcribing voice- or video-recorded medical reports from healthcare professionals.
• It’s crucial to keep an editable and formatted file. Make sure the transcription is accurate and free of any misleading or incorrect information that might endanger the patient’s health.

Medical Coding:

• To make the process simple and quick, the transcripted information is transformed into medical codes.
• Medical coding is the process of converting a patient’s condition, medical treatments, and prescriptions into codes.
• It takes longer to read the patient’s whole medical history. As a result, it is coded.
• Medical coding is only done by the medical staff. They should be knowledgeable and adept in certain facets of medical coding.
• Coders translate the medical record into medical coding by using DX (the patient’s condition) and CPT (the service provided to the patient).

Charge entry:

• Before filing a claim with the insurance company, charges for the services performed are precisely included on the sheet.
• Medical data for patients are carefully tracked and charged with the proper amount.
• The medical billing business will submit a claim with insurance for payment of the entered charges.
• If there are any mistakes on the charge input page, they might show up in the claim.
• Accurate input is required for simple revenue claims and payment posting.

Charge Transmission:

• Charge transmission refers to the process of sending appropriate claim codes via EDI (Electronic Data Interchange) to the insurance provider.
• Only error-free, clear claims will be sent over EDI.
• There are three levels of transmission errors:

1. Scrubbing- Mandatory fields has to be filled without any mistake. Otherwise, the software would reject the claim.
2. EDI rejection- Invalid information held in the patient’s record will cause claim rejection by EDI.
3. Payer rejections- Rejection in claims occur according to the insurance guidelines and payer details.

• Only after these first three levels are handled are denials or payments.
• Claims for payment for medical services are transmitted in a safe and encrypted manner.

AR Calling:

• The caller for AR focuses on reducing rejections and boosting payment flow in RCM.
• Their prompt follow-up with the insurance provider boosts payment receipts.
• The primary goal of the AR caller is to guarantee payment posting for the services provided by healthcare professionals.
• They have a duty to share accurate patient information and to correct any mistakes that are discovered.
• correspondence and reply letters from the patient’s insurer.

Denial Management:

• An essential component of revenue cycle management is denial management.
• It encourages a successful revenue increase by lowering insurance company denials.
• dealing with the denied claims on numerous fronts and continuing to follow up.
• putting necessary measures in place to boost revenue payments and reduce rejections.
• To lessen the likelihood of future denials, identify the reasons for them.
• The rejection management team evaluates and conducts research on each denied claim to determine the best line of action.
• quicker payouts for claims that were rejected in a short amount of time.
• Prioritize rejected claims according to payer, amount, and other factors to provide the highest possible payouts.

Payment Posting:

• The payment posting team’s responsibility is to make sure that patients get payments on time and without being denied.
• Involved patient claims will be updated with any EOB (Explanation of Benefits), correspondence, or ERA (Electronic Remittance Advice) that the insurance company sends.
• The posting team records denials and payments using EOB or communication receivables from insurance carriers.
• The posting team must match the bulk payment receivables in order for the check amount to match.
• Revenue from patients and insurance will be determined using the payment made to the practise accounts.

These 10 stages raise the bar for medical billing in revenue cycle management by ensuring continuous revenue development and gaining access to a large number of medical claims with fewer mistakes and denials.