Claim Preparation Process in Medical Billing

Posted by Business Integrity Services on May 25th, 2021

If you're a healthcare provider, you are aware you have to start on the claim preparation and billing procedure after treating a patient. If you're unfamiliar with the process, then the job will undoubtedly be unsettling.

But you can always seek the help of a medical billing company.

For instance, if you're a therapist, you can hire a third party physical therapy billing company with the tools and experience to quickly and correctly complete the billing process. In any case, the outsourced biller will peel off all the anxieties and worries that come with medical billing.

But before you hire an expert for your job, let us familiarize you with how the claim preparation procedure functions.

1.Patient Registration

When a patient publications an appointment via phone or physically checks into your practice for the first time, they should register by providing their details. Some clinics give patients a form to meet their insurance and demographic details.

Some of the data captured on the form could comprise:

· Patient names

· Physical address or telephone number

· Date of birth

· Social Security Number

· Title of the insurance company

· Name of the policyholder

· Policy amount

The private details can help the clinic determine whether the patient is eligible for services offered depending on the insurance policy coverage. The individual's identity should also be confirmed once they give their information to be certain they are not using another individual's coverage. This may be done by assessing their government-issued ID or any other sort of identification.

If your clinic fails to verify the patient's individuality, you will be liable for fraud when the individual uses somebody else's coverage as their own.

2.Insurance Eligibility Verification

Insurance coverage is often different between providers, plans, and individuals. Thus, the biller should confirm the individual's eligibility for the services offered.

If the insurance doesn't cover the services to be rendered or a part of them, the biller should let the patient know.

Part of this step also involves assessing whether the patient's insurance policy cover has elapsed or prior insurance authorization requirements to be met before offering the treatment.

3.Medical Diagnosis Coding and Procedures

After the conclusion of the first paperwork, the individual will go and see the doctor. The doctor's medical record, also known as the superbill, is transmitted to the medical coder. The data from the report should be properly coded.

Accurate coding is essential since it empowers the insurance company to rate the claim correctly. Medical coders need to be cautious to avoid under or over coding mistakes. The coder should also follow the Current Procedural Terminology and International Statistical Classification of Diseases codes.

Clinical documentation justifying the coded claim has to be available. Adding such attachments into the coded claim raises the chances for the promise to be prosperous. Some medical procedures also need further documentation, which may shorten the claim process if the documentation is contained in the first submission.

Claims Frequently Have a similar arrangement, and some of the advice provided includes:

· Patient Details

· Procedures performed

· Cost of the processes performed

· Provider information under the National Provider Index number

· Location of service code or the Kind of facility

4.Claim Submission

When the claim is prepared, it ought to be submitted to the insurance provider for payment. If your health facility is covered by the Health Insurance Portability and Accountability Act (HIPAA), you should submit the claim electronically.

Electronic claims have fewer errors, are more effective, and take less time to get to the payer. Billing electronically also saves your training money and time.

The provider also needs to check if they will need to prepare a claim with a payer-specific billing guideline.

5.Claim Resolve

When the payer receives the claim, they assess it and decide whether the claim is legitimate and how much they will reimburse the supplier.

At this phase, a claim will be accepted if it's shown to be valid. It might also be reversed if it is discovered to have some errors. If the claim is rejected, it is sent back to the biller, which corrects the errors and resubmits them. A claim may also be refused where the plaintiff decides to not process the payment for the services provided.

When the claim is accepted, the payer also sends the biller a report detailing the claim amount they will pay. If some medical procedures will not be insured, the plaintiff provides reasons why.

If the biller does not agree with the payer's report, they may elect to pursue a claim attraction where they try to secure the ideal reimbursement for services rendered.

6.Payment Statement Preparation

This final step involves preparing a statement to get your patient detailing the amount paid by the insurer. The statement also provides the bill's part that the individual has to pay from their pocket. Medical invoice statements ought to be timely and accurate.

The biller must follow the individual to make sure their part of their medical bill is paid. When the individual pays, this is recorded in their medical history.

In conclusion, the claim preparation and billing process can be daunting if you do not have enough time or knowledge to finish it. A medical billing company can help you with the claim preparation process leaving you enough time to Concentrate on your patients.