Steps in Medical Billing Process
HCA/220
June 17, 2012
Deborah Ryan

Steps in Medical Billing Process
The medical billing process is divided into three main categories and ten separate steps. These categories are the “visit” that contains the first four steps. The “claim” process contains the next three steps. Finally “post claim” contains the final three steps. The steps are listed as follows: 1. Preregister patients 2. Establish financial responsibility for visits 3. Check in patients 4. Check out patients 5. Review coding compliance 6. Check billing compliance 7. Prepare and transmit claims 8. Monitor payer adjudication 9. Generate patient statements 10. Follow up patient payments and handle collections

The first step is preregistering patients. Patients call into the office. At this time
Patients are asked what type of insurance they have. All offices do not take all insurances, so it is important to ask first before scheduling. The scheduler then asks why the patient needs to be seen and a time is set. At this time, information such as name, contact information, and date of birth are collected. The second step is establishing financial responsibility for visits. The patient’s insurance is then verified. Their insurance is then checked to see if procedures are covered or need preauthorization. After verifying the insurance, copay is determined followed by the patient’s financial responsibility to procedures that are not covered. If the procedure is not covered or the patient is uninsured, sometimes payment plans can be worked out for the patient. The third step is to check in the patient. New patients are typically asked to fill out paper work and the insurance cards and form of identification are taken. Existing patients are asked to verify that none of the information has changed and if it has, that it is updated. All cards are copied front and back and put into the patient’s medical records. If a copay is needed, it is collected at this time. (Introduction to the, 2008) The forth step contains checking out the patient. The Doctor writes down the procedures that were performed and the medical diagnosis. Medical coders then take the information and assign it the proper code for the billing process. The patient’s balance and medical codes are then entered into the records. This is the final step for the visit process. The fifth step is reviewing coding compliance. This step ensures that all guidelines were followed. All documents are checked for errors. After errors are checked, the patient’s documents are then broken down so the patient can see what services they are paying for. The sixth step is checking for billing compliance. This step involves making sure that the codes used in the visit’s procedures can be billed. The payer’s rules are