Medical Billing and Coding Process

Step One:
Preregister patients-Patients who call in order to schedule an appointment have to provide basic information. General information usually includes the person’s first, middle, and last names along with their address, the reason for the encounter, their basic insurance information, and the most convenient date and time of the appointment. During the encounter:

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Step Two:
Establish financial responsibility-The person behind the window will inform the patient on whether or not they are eligible for that specific health plan, check the factors that are covered under that health plan, determine the first payer if there are more than one health plan that actually covers that patient, and meet the payer’s conditions for the payment. Step Three:

Check in patients-Returning patients are required to sign in at the front desk of the facility. They usually are asked to review previous information to make sure that it is accurate and up-to-date. Their financial records are also checked to make sure that previous balances were paid at the time of the previous visits. If a new patient arrives, they are required to fill out a form that includes their personal information and show proof of their identification as well as proof of their insurance. This helps to eliminate fraud or malpractice in the facility. The patient’s personal information and insurance information will then be copied and returned to the patient. This information is entered into the facility’s database for future reference. The front and back of the insurance cards and other identification cards are scanned and copied in order to be storied in the database. Copayments are always collected at the time of the service, some are collected before the encounter and some are collected after the encounter. Some facilities require other forms to be completed by the patients, these forms are included as part of the process of recording administrative and clinical facts about patients. Step Four:

Review Coding Compliance-In order for billing options to be carried out to the patient, medical codes must assign the medical procedures and diagnoses. The physician does specific codes for specific treatments and procedures. The treatment that the patient receives from the physician is entered into the database. The treatment and procedures that the patient receives have to be completed and signed by the physician. At the end of the patient’s visit, the physician gives the form (with the checked-off treatments and procedures) to the individual at the front desk. That person then in turn gives the form to the billing function of the facility. After this is done, they set up a patient’s next appointment. Step Five:

Review Billing Compliance-After the facility transfers the patient’s diagnoses and procedures to billing, the file is then checked by billing in order to determine if the specific billing options are correct or not, and to make sure that reimbursements are returned to the patient in a timely fashion. Every fee or charge has its own specific procedure code. Usually, the physician’s charges are applied to the medical practice’s fee schedule.

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