Whether you are a healthcare provider just starting, or you are looking to improve your understanding of the medical billing process, this article is for you. In it, we will break down each step involved in billing and collecting payments from patients. We will also discuss some of the most common issues healthcare providers face when billing patients. By the end, you should have a strong understanding of how the entire process works – and what you can do to make it run more smoothly.
1. Patient Information
The first step in the medical billing process is gathering patient information. This includes all of the necessary details for a patient’s chart, such as their name, address, and any personal or insurance information. Your staff should be trained to take down this information accurately and legibly. It also helps if they can do so promptly – but that’s not always possible when you’re dealing with people at their most stressed out. So what happens if your staff misses something? Or even worse, completely gets it wrong? If it’s something small, like changing Iva Smith to Eva Smith on the file, then it’ll just need to be corrected later on. However, missing or incorrect addresses can lead to situations where patients never receive statements, get bills or make payments. This results in bad debt, which can be very difficult to get back.
2. Getting Ready
After you have all of the relevant information for your patient’s file, it is time to “get ready” for billing. This step involves collecting any co-pays or deductibles your patients are responsible for paying when they receive care at your practice. It also includes gathering insurance cards and checking coverage in advance of services being provided so that there are no surprises later on in the process.
3. The Billing Process
The medical billing process refers to the steps taken after a patient receives care to submit claims and collect payment from their insurance provider(s). Not only is this an incredibly time-consuming process, but it is also very easy to make a mistake. That’s why most healthcare practices have dedicated medical billing staff on their team. Below are some of the common issues providers face when billing patients:
• Missed CPT/HCPCS Codes – Coding refers to how physicians report injuries, illnesses and treatments. Each code corresponds with descriptive words or phrases (e.g., “first visit,” “mild,” etc.) that provide additional information about what was done during care, which conditions were treated and how long the visit lasted. If the correct code for services provided is left out or incorrect, then payment will be denied or significantly reduced by insurance because claims lack sufficient detail.
• Missing/Incorrect Patient Information – If a patient does not receive their statement or gets a bill for the wrong amount, it can lead to bad debt. Be sure to double-check that your patients’ names and insurance information are correct before submitting claims.
• Ineligible Claims – For claims to be eligible for payment from an insurer, they must meet several criteria set by the insurance company itself – as well as state and federal regulations. If even one criterion is missing or incomplete, then a claim will likely be denied. While many denials can be appealed successfully, this process takes time – meaning you’re further delaying reimbursement. It’s important to know which tasks count as “practice expense” versus those that are “capital” in nature.
• Wrong Prior Authorization – This is when a claims administrator requires further information or documentation before agreeing to pay an insurance claim. A common reason for this request is that the services rendered are not covered by the patient’s plan, so they require specific prior authorization to receive reimbursement. First of all, make sure you have your patients’ most up-to-date contact information. If they’ve moved or changed their number, then call them directly to make sure that they are expecting your statement/notice/bill and can pay what they owe.
4 . Billing Services
As healthcare providers become more advanced in their knowledge of billing practices, many choose to hire outsourced billing companies to handle tasks such as patient statements, claims submission and payments. This can be a great option for practices with a small number of patients because it ensures that every co-pay and deductible owed will get collected without any problems. Studies have shown that practices that outsource billing get more payments from insurers than those who do not – which means they get paid faster too.