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The Medical Billing Process

Preregistration – The medical billing process begins at the point of contact from the prospective patient. Preregistration is the first step in the Medical billing process and the revenue cycle. It is the time to gather demographic and insurance information. This information is vital to the successful adjudication of your medical claims and vital to the financial success of your practice. This step in the billing process has several front end processes. Failure to address these front end processes can and will cost your practice time and money.

Demographics – Demographic information is the patient’s personal information. It includes the patient name, address, phone number, and work phone number, date of birth, gender and social security number. This information will be important when communicating with the insurance company for claims follow up and future contact with the patient. Demographic information is personal and needs to be protected in order to comply with HIPAA (Health Insurance Portability and Accountability Act) rules and regulations.

Insurance Information – The preregistration step is also the time to gather insurance information. Since this is how your practice will get paid for its services, it is worth taking extra time at this front end process and make certain this information is captured accurately. The name of the insurance company, the name of the insured if the insured is not the patient, type of policy, the ID number and the phone number for the insurance company are critical pieces of information. If you can obtain the mailing address for claims, it would be advantageous to do so at this time. Each piece of insurance information is vital to successful adjudication of the claim.

Compliance with insurance company policies – By obtaining the insurance information before your patient arrives for their first appointment, your practice will be able to verify eligibility and benefits, obtain the required authorization, obtain proper referrals and verify co pay and deductible information. The following information is critical to the billing and collections process and to the success of your practice. I want to stress that it is of the utmost importance to the practice for this information to be accurate. Failures to obtain proper referrals, precertification or preauthorization are all causes for denied claims. Collecting the co pay at the time of visit will save you the cost of printing a statement, envelope and postage and also the man hours to do follow up on a ten dollar balance.

Be Precise and Accurate – Since your staff has taken the time to obtain the demographic and insurance information, they should also take the time to enter this information accurately into you computer system. A couple of extra minutes spent on entering this information correctly will save time and money trying to fix mistakes and re-submitting rejected or denied claims. It is frustrating to say the least for a claim to be rejected or denied because of an incorrect digit in an id number or a patient name that is misspelled.

The cost of inaccurate information – Inaccurate demographic and insurance information is costly to your practice. It leads to rejected and denied claims. When claims are rejected or denied, it takes time or man-hours to research the denial reason, correct the inaccurate information and resubmit the claim. Inaccurate information leads to increase labor and resources to adjudicate the claim and delays the cash flow of your practice. It substantially can impact you bottom line.

Source by Samuel D. Deutscher

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