The process of medical billing can be frustrating. Insurers are often strict about how claims are formatted for approval and converting patient notes to numbered claims introduces human error. Even when claims are approved, insurance providers rarely pay right away.

The best thing you can do is to streamline your medical billing process by following these steps.

10 Steps to Streamline Your Medical Billing Process

Register the patient

The first step is to register the patient. This is done by the front office staff when the patient calls for their first appointment. They will be asked a series of questions including demographics, insurance information, and other key pieces of data.

Many medical billing guides state that once this information is collected, it never has to be done again. However, it is important to confirm the information so that you can change outdated contact and insurance info.

Verify Insurance

This step is simple. Once you have the patient’s insurance information, you will contact the insurance provider to confirm coverage. Typically, the insurance card will have a phone number that you can call. When you reach a representative, ask about the validity of the patient’s coverage and the benefits they receive, including deductibles and co-pays so that you know what you need to collect from the patient.

Sometimes, an insurance plan will not entirely cover your services. If the patient has secondary insurance, you should contact them and see if they will cover the remainder of the bill. If not, the patient needs to be notified of their financial responsibility. Ideally, this should be done before their appointment so they can cancel if they are unable to afford services.

Take Detailed Notes During or Immediately Following The Visit

During the visit or immediately after, you should jot down detailed notes including diagnoses, treatments/services, and prescriptions for medical coding. This information should be stored in your electronic medical records.

Send Notes to The Medical Billing Team

Once your notes are complete, they should be converted to a formal medical script so that others can read them.

If your notes are voice-recorded without voice-to-text tools, they need to be transcribed before being sent to the medical billing team. You may not have the time to do this yourself, so this task may be delegated to your front office staff or outsourced to a medical transcription service.

If your billing is handled in-house, the medical script should be sent to your front office staff. If outsourced, the script should be sent to the billing service.

Convert Medical Script to ICD-10 and CPT Codes

Your medical script will eventually be given to a medical coder, who will translate the information into standard ICD-10 and CPT codes. These codes are used by insurance providers to determine whether or not they will cover the services based on the patient’s plan. Eventually, the codes will be entered into a medical claim along with your charges and the patient’s demographics.

Add Charges to Medical Claims

While medical codes are standardized, fees are not. You’ll need to enter your charges in the claims. For example, if your primary care visit is $300, this amount will be listed with the primary care CPT code in your claims.

If the patient must cover any part of the services, you must list what the insurance provider covers along with your charges. This way, the payer knows how much they need to deduct from their reimbursement, so you don’t get paid twice.

Scrub & File Claims

Since there are so many codes and numbers being entered into claims, errors are common. However, a claim scrubber can help you catch most, if not all, of these errors before the claim is filed. A claim scrubber is a fully automated software program that knows what to look for in claims.

Once the claims have been scrubbed, they can be filed. If patients are on Medicaid or Medicare, you can file directly with them. If you establish a strong relationship with just a few providers, direct filing may be easier. However, if you accept a wide variety of insurance providers, you may find it easier to go through a clearinghouse. They will take your scrubbed claims and format them appropriately, which can help you avoid rejected claims.

Watch for Payer Adjudication

Once your claim has been received, adjudication begins. This is the process by which the payer determines if the claim will be approved, denied, or rejected and how much of the claim you’ll be reimbursed. Typically, rejections are due to coding errors rather than the decision of the provider to not pay the claim. Rejections typically include instructions on how to fix the errors.

That being said, even when a claim is perfect, the insurer can deny it. If this happens, the billing team should review the decision for inaccuracies. If any errors are discovered, you can appeal, though the process is lengthy and expensive.

If the claim is denied because the provider doesn’t cover your services, you must notify the patient. At this point, if they have secondary insurance, you can submit a claim to that provider, or the patient can pay the non-reimbursed amount.

Send a Statement to the Patient

If there is still a balance once the insurance provider has paid, you must send them a statement with their charges listed, as well as an explanation of benefits that shows what their insurance plan covers and what it does not. This will let them know that they owe a balance.

Payment instructions and due dates should be listed on the statement, as well as information on how they can appeal the claim denial if they wish. Many times, the medical practice deals with appeals, but the patient can file their own if they wish.

Pursue Payment

If the claim was approved, you’ll need to pursue payment from the payer. In many cases, a lot of time may pass between approval and reimbursement. However, by paying attention to your accounts receivable, you’ll know which claims have been paid and which have not. Follow up on the ones that are delayed until you receive payment.

If the claim is denied, the patient is responsible. Your billing team should follow up with them until they pay. If they do not, you may want to consider sending the bill to a debt collector. However, this should be a last resort because healthcare is expensive and not everyone can afford large payments. Therefore, try to sympathize with your patient. You may want to offer them a payment plan that fits within their budget. After all, it’s better to get small, regular payments than nothing at all.

Want to Learn More?

If you want more guidance on streamlining your medical billing process, contact First Class Lending for more information. We will be happy to walk you through the process.