05/28/21
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If you work in the healthcare industry, chances are you’ve been asked this question more than a few times: what is medical billing, and how does it work? For medical professionals, the practice is second nature. It’s something billers have to do in order to receive reimbursements to earn revenue that keeps their company in business. In a nutshell, medical billing is the process of creating, submitting, and following up on claims after a service is performed. Medical billing can seem like a huge, daunting undertaking, and it definitely can be. But a careful, precise process makes for a smooth billing cycle. Medical billing can be better understood when we examine it step by step. The following outlines the main steps medical billers take to submit clean insurance claims. 

Patient registration

When a patient makes an appointment with their healthcare provider, they need to provide both personal and insurance information up front. This could be done over the phone or in person, but the same information should be collected in either case. Even if the patient has visited this facility before, providers should verify insurance coverage to ensure nothing has changed since their last visit. Once providers have a patient’s demographic and insurance information, registration is complete. 

Confirm financial responsibility

Insurance coverage varies from provider to provider and is different for every person. As such, it’s crucial that healthcare providers confirm how much insurance covers for the requested service before the appointment. If an outstanding balance is left after insurance coverage is applied, the patient needs to be made aware that they will be responsible for that balance. 

Create the superbill

When a patient’s appointment is over, it’s time to create the document known as the “superbill.” Information from the appointment is sent to a medical coder to be translated into a coded medical report. The report includes information about the appointment and any services performed, along with the patient’s demographic info and medical history, and the name of the physician, provider, and any diagnosis and procedure codes. 

Prepare the claim

After a medical coder creates the superbill, it’s time to translate all of that information into a nice, usable claim. Many people still put their information into paper claims, but the best way to create an error-free claim is with the help of non emergency medical transportation billing software. When billers use software, they reduce the number of rejected and denied claims they receive, plus they save time by billing and submitting in just minutes. If you’re submitting your claim via NEMT software, it’s easy to monitor a claim’s status and keep track of any issues that arise. 

Monitor adjudication 

Once you send the claim off, the results are out of your hands. You’ve completed your side of the work up until this point, so it’s time to see what the payer comes back with. There are a few different possibilities at this point. A claim will either come back accepted, rejected, or denied. If you receive a rejected or denied claim, you’ll have to fix the problem cited as the reason for the error and resubmit. If your claim is accepted, the payer will send back a report detailing what they will and won’t pay. 

Create the patient statement 

If any outstanding balance remains after the payer contributes their portion, the patient will receive a statement for their part of the bill. They may also receive an explanation of benefits explaining why some services were covered and others weren’t. 

Follow up with patients 

Ideally you won’t have to do this step regularly, but if a patient is late paying their portion of the bill or hasn’t paid it in full, it’s the biller’s responsibility to follow up and make sure that payment is made. 

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