10 steps in the life cycle of the medical billing

medical billing cycle

Medical billing starts from the patient’s appointment at the doctors office to the time when the doctor’s get detail reports from the account team working at the doctor’s office. When patient visit the doctor the first thing doctor would ask the patient if he or she a medical insurance to cover the expenses incurred by the physician or the hospital. If the patient has an effective medical insurance from an government or commercial company, he or she would give an appoint date on which patient will receive the service. Because the doctor wants to make sure that insurance will cover the charges that would incurred in the office of the doctor. There are several other steps involved in the life cycle of medical billing that we will discuss in detail in the next heading.

10 steps in the life cycle of medical billing

1. Appointment 

The first step in the medical billing cycle is when the patient checks in the hospital for get a date at which the service will be provided to the patient. Appointment can be done by a call at the doctor’s office. Patient can also access portals to know the dates and time of their appointment. Also they can check any previous dates during which the service is provided to them by the same doctors or any other providers. Walking patients are the one that visit the doctor’s office and after giving his or her demographic information would get a date on which the service would be provided to the patient.

2. Eligibility

Eligibility is an important step in the life cycle of medical billing. If the patient insurance plan is effective during the date on which the service would be provided would lower the chances of any kind of denial that would incurred in the later stages of the medical billing cycle. Eligibility includes member name, insurance name and type of insurance such a medical, dental, or vision. It also include the during on which the service would be provided. Billing special can acquire whether the patient has one or more insurances, and if there are two insurance which would be the primary insurance of the patient. If all done well would decrease any chances of denial of the claim that doctor office charge to the insurance company.

3. Demographic Entity

After eligibility billing staff will enter the patient data in special software i.e. EHA designed for keeping the demographic and health records of the patient. Doctor will also ask the patient some demographic information such as date of birth, name, members SSN number, phone number, address and other patient’s information.

4. Decoding

Doctor in his office keeps a paper form that is Superbill on which is listed the CPT codes that represent the specialty of the patient. If the patient need medical assistance for any injury at any area of the body, he or she will visit the doctor who is specialized in providing assistance against the patient’s need. Superbill list that kind of service that doctor provide everyday to any patient that visits his or her office. He or she will mark the CPT codes and will send the super bill to the billing team who then will make the claim for reimbursement.

5. Charge Entity

Against each CPT code insurance company has a detail pricing policy on their website for the providers. Medical billing specialist will require that information that they will enter against each cpt code while making a medical claim.

6. Claim submission

As medical billers make a solid claim they will send the claim to the insurance companies electronically via HSA or by FAX. They can also mail the claim at the address of the company’s office. Paper claims are faxed to the insurance on a CMS 1500 or UB04 format.

7. Payment posting

Account receivable specialists of the medical billing team would enter the data that they obtain from insurance companies as a record in the HSAs. Insurance companies would also send electronic remittance advice or paper eobs to the medical billing team working at the doctor’s office.

8. Denial Management

Sometimes insurance companies denies the payment of the medical due to a number of reasons. Account receivable team or specialized team manages the denials that they receive for the claims of the patients of all the different types of insurances.

9. AR Follow up

Account receivable or specialized denial management team will work on the claims that are denied by the insurance companies. They will ask for the reason of the denial and the will do everything in their end to make sure all kinds of faults get remove from the claims in order to be paid.

10. Reporting

Last step in the medical billing is reporting. AR team executives make detail payment report, claim reports, and denial report to be sent to the doctor’s office. They can also keep problem sheets at their end for the purpose of further processing. Some popular HSAs include Collaborate MD, Advanced MD, Dr Chrono, and other a likes.

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