Medical billing can be very confusing. Most people assume that it is a bill you will get in the mail and must make the payment. What they don’t know is that there is so much more to medical billing than they think. This is one of the reasons why over half of all Americans don’t understand the medical billing process. Here are some insights on the medical billing process and its purpose.
What is Medical Billing?
Medical billing is when you are obtaining the insurance information from the patient. You are filing the claim with the insurance company and following up to ensure that everything is paid. You will code different things into the bill based on the prices, treatment, and procedure. The insurance company will pay the claim within 30 to 45 days after receiving the bill.
The goal is to prepare and submit the claims for the timely payment of the bill. Healthcare organizations are reimbursed for these services, with the patient paying a certain percentage.
These are the objectives of medical billing in Tampa, and it plays a critical role in how you receive the payment.
The Process
The process involves the front and back end for successful medical billing. Here are the steps for the front end
- Registration: The first step is when the patient comes to the provider for treatment.
- Eligibility: The healthcare providers must verify that the patient’s health plan covers these services. You determine what the patient owes and bill them.
- The encounter form: An encounter form is when a ticket is created for each patient. It contains the medical codes, services, notes, and demographic information.
The back end process involves more steps to ensure everything goes smoothly including
- The charges: This verifies the procedures and why they were performed. These are entered into the practice management system.
- The claim: After the charges and payments are entered is when you generate a claim.
- Scrubbing: This is making sure that all of the information is accurate.
- Forms: The forms are submitted to the insurers via CMS-1500 or UB-04.
- Submission: The information is submitted to the payer electronically.
- Tracking: This step involves tracking the status of the claim daily.
- Posting: These are the direct payments that the healthcare provider or physician receives.
- Patient payments: The patient receives a bill stating the amount that is owed.
- Denials: This deals with claims that are denied by the insurance company and must be reconciled.
- Collections: Collections are contacting the patient and finding out when they will cover their part of the healthcare costs.
The purpose is to ensure that you get the full amount for your fees from the payer and patient.
Putting the Process Together
This shows how the process of medical billing works. The purpose is to ensure the timely payment to you. Medical billing in Tampa can be complicated, and sometimes the process can be time-consuming. Outsourcing is one solution that can make things easier and help you to free up time and money.