Running your practice is much more than diagnosing illnesses, prescribing medication, or performing surgery. There’s also the business side of running a medical office, or any business really. Having medical billing procedures in place–and sticking to them–will ensure you’re being reimbursed for all of the services you offer.
Your medical billing procedures should start with your initial patient contact and end when the bill is paid. That might sound like a lot, but if you break it down into smaller steps, it’s not so daunting. Following the right medical billing process is a critical step in keeping your healthcare practice up and running.
Medical Billing Procedures
If you’re just getting started with medical billing, or if you’re looking to improve your current system, here are a few key steps to include in your medical billing procedures:
- Register the patient
- Verify insurance
- Record visit information
- Send visit information to the billing team
- Add appropriate codes
- Prepare medical claim
- Review claim
- Insurance review
- Prepare patient statement
- Payment/follow-up if necessary
Create a patient registration form that captures all of the important data you need, including patient demographics, provider, insurance identifiers, and other pertinent information. This information will be used for every following visit and the medical record will be updated as needed.
When patients come in for their appointment, verify their insurance information and coverage and ask for an insurance card to make sure you get the correct info. This step is important to avoid any billing surprises later on. On repeat visits, you’ll still want to make sure they have the same insurance information you have on file.
During the appointment, document all of the services and procedures performed. This documentation will be used by medical coders to apply the codes that most represent the services provided. On the first visit, you want to get a medical history and review it for changes on subsequent visits. All of this information will be included in the medical transcription.
Once the transcription is reviewed, it will be prepared and sent to your medical billers. Some providers have an in-house team or use a third party like MBA Medical Services to handle the coding and billing. That’s why making sure the record of the visit is thorough and clearly described. This is when the procedure codes are applied to the visit record, also known as a charge entry.
Next, the medical claim will be sent to a third party to review and process the claim. This is known as “scrubbing” and will look for any issues or mistakes that may have been applied before sending it off to the insurance payers for reimbursement. Software is used to make sure all form fields are correct as well as reformat for specific companies.
The insurance company will review the claim and look for any discrepancies. If there are mistakes, or there are procedures that aren’t covered by the patient’s plan, the claim will be denied. In most cases, the insurance companies will explain a denied claim so any problems can be rectified.
Once the claim has been accepted and you are reimbursed, the leftover balance (if there is one) will be sent to your accounts receivable team. They will prepare a statement explaining the remaining balance and send out the invoice.
When the bill has been paid, this revenue cycle has been closed. However, you may need to track down any past-due bills, which for many practices is the hardest part of the process. It’s important to have a diligent team to ensure you get reimbursed for the services you provided.
Having well-defined medical billing procedures in place will help ensure your practice runs smoothly and you’re getting reimbursed for all of the services you provide. It might take a little bit of time to get everything set up, but it will be worth it in the long run.
It is easy to miss out on payments or end up with patients who have not paid their bills. By taking the time to set up your medical billing procedures, you can save yourself a lot of headaches down the road. If you’re a small office with high traffic and a small staff, it can be difficult to get a handle on things. That’s where MBA Medical Billing Services can help.
Let MBA Medical Help With Your Medical Billing Procedures
We know it can be overwhelming working with patients, the business of running a practice, working with insurance companies, and so on. As legal requirements change, codes are updated, insurance processes are altered, it can seem you’ve only just mastered the last round of updates.
You went to school to practice medicine, not run the business office. MBA Medical Billing has decades of experience with medical billing procedures and works with hundreds of healthcare providers to keep their books up to date and business best practices streamlined.
We can either take over the medical billing for your company or help train your staff to be more efficient, make fewer mistakes, and keep up to date on patient billing. That way you can concentrate on treating your patients and giving them the best care possible.
If you would like to know more about our medical billing and coding services, or other services including credentialing, medical IT services, and general bookkeeping practices, reach out to MBA Medical billing for help. We’ll perform an audit of your current processes and find areas for improvement. We look forward to hearing from you.