The medical billing and coding personnel has great responsibilities on their shoulder to monitor the financial charts of the doctor’s office, generate maximum revenue and consequently maintain the financial stability of the doctor’s office. Hence it can be said that medical billing and coding professional has the main key of success for a medical practitioner. Below we have tried to include step by step process or scope of work, a medical biller is expected to undertake for an individual file. It can also be summarized as a medical biller’s to-do list.
Steps Necessary before the Appointment Day:
The process of medical billing and coding starts well before the patient actually comes to visit the doctor! And it continues till the final reimbursement of money from the insurance agency. Any loopholes or miscommunication in this process will lead to delay in generating revenue for the doctor. It is important that the patient’s insurance benefits are verified well before initiating any procedures of medical billing and coding. For this the patient should be called before hand with all the necessary documents, papers and medical reports. If the patient fails to show up for this purpose the same should be notified to the concerned Primary Care Physician and the same should also be noted down.
Office Manager’s Checklist on Appointment Day:
First thing to be done from the patient shall be to fill up the detailed patient information sheet or upgrade their information in case they have not visited the physician for more than 6 months. Also the patient’s necessary documents like ID proof; insurance cards should be copied by the medical billing staff. Then they should also get the patient to sign the Assignment of Benefits form and the HIPAA form so that the medical biller has all the necessary documents required to file the claim smoothly. After the patient has been checked by the physician it is the medical billing and coding staff duty to collect the co-payment from the patient and make the patient sign the further payment plans.
Medical Billing Personnel’s Procedures after the Appointment:
Soon after the patient’s appointment with the medical practitioner the medical billing professional is expected to pen down each and every check-up details of the patient, their reports, their past reports and also the information provided in the superbills. The medical billing and coding expert is then expected to convert the whole process in an alphanumeric code carefully according to the coding standards.
But the process of documenting the patient’s visit should only be done by the healthcare practitioner as it would be a serious offence if the medical billing staff enters wrong charges and diagnosis for the wrong procedure. Only then a medical billing and coding staff can compare the data entered into the superbills and generate the code. While filling certain claims it is also necessary to attach certain detailed reports for easy and quick processing of the claims.
Billing the Patient:
Generally the medical hospitals and institutions that tie-up with health insurance firms are supposed to send the complete medical bills to the insurance industry first and the billing is sent to the patient for any pending residual amount only after reviewing the EOB.
In case the patient has deductible amount to be deducted from the patient’s medical bill, it has to be deducted right away from the medical bills and only after the deductible limit is over; the insurance companies become liable to pay.
Understanding the Deductible Rule:
If the patient has $300 deductible limit with a 80/20 policy and gets the medical bill of $500, the first $300 are liable completely to the patient. From the rest $200 the insurance firm has agreed on an 80% limit which makes to $160 as liability of the insurance firm and rest $40 as the patient’s liability.