Medical billing process step by step

Medical billing process step by step

Medical billing process step by step: Medical practices can expect to pay between 4% and 10% of their total collections to the billing service. Some medical companies charge a flat fee. There can be many different ways. Medical billers strengthen the relationship between the healthcare institution and the patient. Here, we will go through the medical billing process step by step. Stay connected.

Diagnostic procedures are determined as soon as the patient’s problem is identified. Once the patient is diagnosed, the bill is paid by negotiating with the insurance companies. When the medical billing process runs smoothly, doctors can concentrate on patient care without any worries. Medical billers link the insurance companies and the patient organization so that everything gets done on time.

Medical Billing Statistics 2024 – Everything You Need to Know

There has been a lot of development in the health sector in the last few years. Due to this, the number of hospital overcharges increased worldwide during the COVID period in 2020, after which the size of the medical billing in the global outsourcing market was estimated to be US$12.7 billion in 2022.

This will amount to US$ 15.12 billion in 2023 at a compound annual growth rate of CAGR. Of 11.8%. Which will increase to US $ 16.91 billion in 2024. It is estimated to reach US$55.6 billion by 2032.

Undertake medical billing step-by-step.

There are some steps to doing every kind of work. Similarly, there are some steps to do medical billing, which we will try to understand, so let’s look at all the aspects.

(1) Pre-certification and insurance verification:

These two steps work first. Pre-authorization is a decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or medical device is medically necessary. Except in an emergency, your health insurance or plan may require pre-authorization for certain services before you can receive them. Pre-authorization is not a promise that your health insurance or plan will cover the cost.

Insurance Verification: In this, it is checked whether the insurance is correct or not, all the installments have been paid by the insured on time, and only after that does the insurance company pay for the treatment.

(2) Patient Demographic Entry:

The patient’s data is prepared based on his/her identity, such as name, date of birth, address, insurance details, medical history, guarantor, etc., carefully entered into what the patient had told after coming to the medical institution.

(3) Charge Entry:

When a patient comes to a medical institution to get his disease diagnosed, a bill for his fees and the medicines he takes is prepared and sent to the payer. After payment is made, further work starts.

(4) Payment Posting:

Payment posting is done so that the insurance companies can settle the payments, and payment posting cancels all the insurance companies’ claims. If any bill remains to be paid, it is billed to the patient immediately. Send it to him and ask for payment quickly.

(5) Claim Submission:

This is one of the most important processes, which takes time and resources. It determines the healthcare provider’s reimbursement after the insurance company clears the outstanding amount. Presenting medicines to insurance companies is challenging as they also reject them. Hence, all things have to be kept in mind.

(6) A/R Follow-up:

In this, the team collects all those claims that the yet-to-be company has yet to accept, prepares them again, and sends them to the insurance company. So that maximum compensation can be obtained. It also has a great impact on revenue cycle management.

(7) Denial Management:

In this, the claims that have been denied are investigated, the medicines are kept in the process of analysis and resolution, and they are taken care of. Rejected claims cause huge losses to medical institutions every year. This can be prevented by having strong denial management processes.

(8) Reporting:

It shows details of all the challenges which are sent and whether they have been paid for. This report includes available WIP, billed amount, and remaining WIP. The report also shows the realization percentage, percentage of WIP billed, and write-up/down percentage. These reports show how healthy our relationship is with the insurance companies.

Wrapping Up!

Let us know the essence of this article.

Here, we discussed medical billing in detail and all its steps. We learned how they work and understood each step properly. Hope you liked the article. From the bottom of my heart, thank you very much for giving your precious time.

FAQS ABOUT THE MEDICAL BILLING PROCESS STEP-BY-STEP

Question 1. What is RCM in medical billing?

Answer 1. When all the medical billing area data is collected on computer software, the process is called RCM. It contains patient details such as name, address, age, past medical history, phone number, etc.

Question 2. What is BPO in medical billing?

Answer 2. When a medical institution hires a third person in its institution for its payment processing, the process is called BPO. The billing company takes a normal fee of 4 to 10 percent of the total.

Question 3. What skills should one have for medical billing?

Answer 3. For medical billing, first of all, you should have communication skills. Along with this, you should know computers and general accounting. With this, you will gradually become more experienced.

Question 4. What is the biggest challenge in medical billing?

Answer 4. There can be some medical billing problems: keeping patients informed, timely payment, easy payment options, rejected claims, lack of proper resources, medical billing software, loss of revenue, etc.