Everything You Need to Know About Medical Coding and Billing Process

Managing financial transactions in medical practices or the healthcare industry can be challenging, especially for obtaining insurance claims. Whether practicing individually or having multiple practicing professionals, any healthcare provider will be handling their area of responsibility and may not have time and resources to work on patients’ insurance claims. This is where medical billing companies in the USA come into the picture.

Medical billing is a step-by-step process involving the submission of insurance claims of patients to the insurance companies to receive payments on behalf of the healthcare provider. This process is complemented by medical coding, which is all about reviewing the patients’ records and assigning correct codes. Let’s explore this entire procedure in detail.

Registration

It all starts here with the registration of the patient. The medical receptionist at the front desk gathers all the necessary information from the patient and arranges an appointment with the doctor.

Following the appointment, the medical biller acquires the patient’s medical records and relative information. However, it’s essential to ensure the authenticity of the data. Remember, here, coding for medical billing is equally crucial.

Insurance Verification

Now comes the second step, where the patient’s insurance verification takes place before meeting with the doctor or physician. The medical billing company analyzes the patient’s healthcare plan to ensure eligibility and policy compliance.

Furthermore, they will also check the patient’s responsibilities, such as deductibles and copayments that must be paid at any cost. It’s essential to have prior authorization from the insurance company before lending healthcare services to the patient. This step alone is enough to tell the significance of medical coding & billing outsourcing companies in the USA.

Patient’s Encounter Form

The patient’s encounter form contains their medical records and the physician-patient encounter information in a well-documented format. In other words, it includes the patient’s procedural and diagnosis codes in correspondence with their examination.

Medical Transcription

In this step, the audio and video recordings of the physician-patient encounter are transferred into a correct billing format. Upon completion, the billing company can finally initiate the billing process. Medical transcription is crucial for medical billing companies in the USA.

Medical Coding

This is the step where the earlier acquired medical transcriptions are put into the coding for medical billing. Simply put, it is the translation of medical reports, including diagnoses, procedures, equipment, etc., into pre-defined codes used across the healthcare industry. Coding is done to reduce the complexity of the reports and to help save time.

Charge Entry/Billing

The billing company would want to complete the bill or charge in the correct form before sending it to the insurance company for the claim. It’s crucial to avoid any mistakes here, as the insurance company can deny the claim in case of any inconsistencies or errors.

Charge Transmission

Charge transmission is all about transmitting the insurance claims to the insurance company via EDI (electronic data interchange). But it must be done with accurate coding and free of errors.

Transmission errors have three levels:

1). Scrubbing: All the mandatory fields must be filled without mistakes; otherwise, the system will reject the claim immediately.

2). EDI Rejection: The information in the patient’s records must be valid. Otherwise, EDI will reject the claim.

3). Lastly, the claims can be rejected if the payer’s policies are not followed.

This is why medical coding outsourcing companies in the USA take claiming process pretty seriously.

AR Management

The AR (accounts receivable) calling team must check every claim upon submission. The primary purpose of this step is to ensure an efficient payment posting process. Furthermore, the AR team will also revise and resubmit the rejected insurance claims.

Denial Management

Denial management plays a crucial role in revenue cycle management; it reduces the denials with the insurance company to promote profitable revenue growth. In many cases, claims are not up to the mark or might have errors. To deal with this situation, the DM team follows up on the claims, identifies errors and inconsistencies, eliminates them, and resubmits again.

Payment Posting

This is the last step in the medical coding and billing process. The payment posting team keeps the healthcare providers updated about the payment status and verifies the accuracy of the payment.

Bottom Line

We have discussed everything you need to know about the medical coding and billing process. It’s entirely possible to handle insurance claims and tasks independently. But outsourcing it to reliable medical coding and billing company can make it convenient for your practice and increase the company’s revenues.