Medical billing processes are complex and are becoming increasingly sophisticated. They also require the cooperation of a number of different employees, working on their own and in concert to gather the information necessary to receive the correct reimbursement from the right sources for each patient.While it's not necessary for each member in a practice to have a full understanding of the entire medical billing process, they must understand, and thoroughly, each part of the process that they themselves will carry out. It's also helpful if they have some understanding of how their role affects the final outcome. On the other hand, it is critical for a professional to understand each role in the process and to be able to contact and communicate with each person taking part in the process.Medical billing specialists must also have an understanding of each entity's responsibilities for reimbursement as they apply to each individual patient. In doing so, they'll need to be able to evaluate each patient's insurance coverage, which may include coverage from one or more companies, government subsidized coverage, and employer subsidized coverage. They have to use this information to further determine how to apply the medical charges listed in a patient's account to each responsible agency, and also determine whether or not the individual is responsible for payment for some or all of the charges themselves.Once they've done this, they will then need to prepare the necessary billing forms to be distributed, offering accurate and thorough information in order to streamline the billing process. Once these forms have been created, they'll have to distribute them and then collect the resulting reimbursement for the practice.
The medical billing process begins as soon as a patient checks in for the first time, and the receptionist will gather the patient's basic information. This information, necessary for medical billing, includes their name, address, birth date, and the reason they made an appointment. Some of this information may be collected prior to the appointment, when the patient calls to schedule it. Using this information, the receptionist or other clerk will then set up a patient file according to an acceptable template. This will make billing easier in the future.Once basic information is collected, information regarding financial responsibility will be collected. This includes insurance company information, plan information, and patient financial information. Then the office can confirm with the insurance company that the current reason for the visit can be covered. After the patient's visit, the services rendered are recorded and added to the file.At this point, the physicians billing service typically takes over, using the medical services recorded to create the billing forms necessary to send to the parties responsible for the costs incurred during the patient's visit. To do so, medical coders will need to examine the services the patient received and translate these into the acceptable billing codes used by insurance companies for their reimbursement services. The claim is this transmitted to the responsible party.