Medical billing is the process of collecting payments from insurance companies for the services provided by healthcare professionals. It seems challenging and time-consuming, but it is crucial for maintaining the financial stability of medical practices.

In this blog, we’ll break down the process step by step so you can have a clear understanding of how medical billing works.

What is Medical Billing Process? 

Medical billing is the process of submitting claims to health insurance companies and following up to receive payment for the services provided to your patients.

This process includes several steps that form the billing cycle. Each step must be completed carefully and accurately to receive prompt payment.

Medical Billing Process Steps 

Medical billing is a complex process. It involves various key steps. Let’s explore the medical billing process and procedures in detail. 

Step 1: Registering the Patient

The invoicing process starts when a patient schedules an appointment. If a new patient visits, their information, such as health history and insurance details, is collected. For returning patients, it’s important to update their files with any changes, like new insurance coverage or a different reason for their visit. It is important to have an accurate record for smooth invoicing.

Step 2: Checking Financial Responsibility

Once the patient is registered, the next step is to check what their insurance covers. Insurance plans often have specific guidelines, which often change frequently. This step helps identify what treatments are covered and what costs may fall on the patient.

Step 3: Recording Medical Codes

Healthcare billing relies on specific codes to represent diagnoses and treatments:

ICD Codes: These codes describe the symptoms or diagnoses.

CPT Codes: These are used for treatments or procedures performed during the visit.

Step 4: Creating the Superbill

After the patient’s visit, all the details are compiled into a document called the Superbill. It includes:

Provider details: 

Name, NPI number, location, and contact information.

Patient details: 

Name, date of birth, insurance information, and visit reason.

Visit Info: 

Date of service, ICD and CPT codes, fees, and the provider’s signature.

Step 5: Submitting the Claim

Using the Superbill, the claim is prepared and submitted to the insurance provider for payment. Submitting accurate and complete claims is critical to avoid delays or rejections. A clean claim—one without errors has a higher chance of approval and keeps the revenue cycle efficient.

Step 6: Insurance Review

The insurance company reviews the claim to decide if it will be accepted, denied, or rejected.

• Accepted: 

The insurer agrees to pay, though not always the full amount.

• Denied: 

The service isn’t covered, often due to policy restrictions.

• Rejected: 

Errors in the claim prevent it from being processed.

Step 7: Creating Patient Statements

After the insurance company pays its portion, the remaining balance is billed to the patient. A clear, detailed statement helps patients understand what they owe and why.

Step 8: Following Up

Following up is an important step for collecting unpaid claims or patient balances. Practices can simplify this step by offering various payment portals, like online payment portals. These payment methods will make it easier for patients to pay their bills on time.

What Are the Responsibilities of Medical Billers?

Medical billers are essential to the healthcare industry, which bridges the gap between care providers and insurance companies. Their primary responsibility is to collect patient information, including insurance and personal details, to create accurate invoicing records. This step ensures that healthcare providers are compensated for their services.

A major part of their job is filing claims with insurance companies and sending bills to patients for services provided. If there are issues, such as rejected claims, billers review the documents, identify errors, and resubmit them. A rejected claim usually contains mistakes in documentation, which must be corrected before they can be processed.

They also manage denied claims. Denial claims are claims that insurance companies refuse to pay due to specific policy rules or coverage limitations. In these cases, billers may need to appeal the decision to help recover the payment.

Another responsibility is to generate detailed invoicing reports. These reports track the invoicing process and identify areas for improvement.

By managing these tasks, medical billers contribute to the financial stability of healthcare facilities while ensuring patients face few challenges with their bills. If you’re looking for a complete and detailed resource on this topic, don’t miss The Ultimate Guide to Medical Billing.

Conclusion 

We hope this article has helped clarify how medical billing works.

As you have seen, billing and coding errors can lead to costly mistakes and unnecessary stress for your practice. That is where Dilijent Systems comes in—your trusted partner in handling medical invoicing.

When you choose Dilijent Systems, you can count on us to handle your invoicing with precision and care. Our team has years of experience and understands the challenges of medical billing. Our advanced systems and thorough processes save you time, reduce mistakes, and increase revenue.

Don’t let billing errors slow your practice down. Let Dilijent Systems support your efforts and improve your financial outcomes. Reach out to us today and find out how we can simplify your billing process while improving your financial performance.

FAQs

What Does ICD Mean in Medical Billing?

ICD-10-CM refers to the International Classification of Diseases, 10th Revision, Clinical Modification. It is a system used to classify and code diseases and medical conditions. Healthcare professionals rely on these codes when diagnosing patients.

How Does Healthcare Billing Work?

Healthcare billing involves assigning codes to record patient visits and treatments. Two major coding systems are used:

• ICD Codes:

These are created by the World Health Organization to identify the conditions being treated.

• Procedure Codes:

These describe the services or procedures provided during the visit.

How Do Medical Bills Work?

When you visit your doctor, the office sends a bill (called a claim) to your insurance company. This bill lists the treatments or services you received. The insurance company reviews the claim and pays the doctor based on your coverage plan.

What Are Common Claim Submission Errors?

Some of the most common mistakes when submitting claims are:

• Entering incorrect patient details, like name or date of birth.

• Providing inaccurate provider information, such as address or contact details.

• Using wrong insurance provider details.

• Typing incorrect or mismatched medical codes.

• Omitting codes for procedures or diagnoses.

• Submitting duplicate claims 

What is CMS in Medical Billing?

CMS stands for the Centers for Medicare and Medicaid Services. This federal agency oversees various programs like Medicare, Medicaid, and the insurance marketplace in United States.

How Does the Billing Process Work?

This process includes several steps to create and send invoices for products or services provided. These steps typically include:

• Collecting customer and service details.

• Generating an accurate invoice.

• Sending the invoice to the customer.

• Monitoring payments and following up.