When it comes to the medical billing, the income of your practice requires you to have the right processes in place. Even if one aspect of this procedure is off, it can greatly affect your revenues. Here are the 7 best signs to determine you have a great medical billing process.
1. Register Patients
If the patient is new, proceed with registration process and verify their demographic information to submit an accurate claim. This includes insurance payer and policy number, if eligible.
2. Insurance Verification
It is necessary that every physician practice verifies the insurance eligibility and its advantages for patients before services are provided. There are many missed opportunities to save income and reduce staff time when patient suitability is not confirmed at the time of check in. Training staff to accomplish this task can help boost income at a time of service and save time on the back end.
3. Charge Entry
At this stage of the procedure, you will enter charges, apply the proper medical codes for the services and processes involved during the visit.
4. Coding of Diagnosis
Coding claims must be done perfectly in order to advise the payer of the patient’s injury or illness in addition to the method of cure. Codes that may be used as diagnosis codes, tell the patient’s illness or particular signs (ICD-9 or ICD-10). Process codes that define the method of treatment provided to the patient (CPT or HCPCS). CPT and HCPCS code modifiers to give additional information about a particular process.
5. Claims Submission
Once the proper information has been added, the claim should then be submitted to the insurance carrier. This needs billing specialists to have the right info on hand for each company since each one has particular criteria that must be met in order to get claims. Failing to follow even one of the necessities can result in a claim being denied.
6. Payment posting for medical billing process
This is the end of the billing cycle, where the payment records of every patient are recorded in the billing software. Payment posting also spawns other procedures which required continuous attention and appropriate action.
7. Secondary Actions
There are few things which must be considered whenever the billing process does not proceed as planned. A few secondary functions that may be taken include:
a) Following up with an insurance company to make sure a claim was received. This should ideally be done between ten days after submission.
b) Resubmitting claims when corrections are required
c) Appealing claims denied for reasons other than registration errors
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