Medical Billing Policies & Procedures

Medical billing is quite a long and lengthy process. There are several steps involved from the time a patient receives care to the time the bill is settled with the insurance company. Medical billing technicians must ensure that data is entered correctly so that each step of the billing process can go ahead without incident.

Claims

• The first step in the process is to make a claim. The hospital or physician will send a claim to their medical billing team. This might be a team that is on-site, a private company or an independent contractor. As part of a medical procedure, the supporting documentation is also sent. This can include charge sheets, demographics and insurance verification data.

Retrieval

• The next step is retrieval. The medical billing team receives the documents and checks that everything is in order. They check for anything that is illegible or missing. Should items be missing or unable to be read, the medical billers have the opportunity to get in touch with the hospital or physician to get what they need.

Coding

• Once all the documents are with the billing team, the coding process takes place. Usually a procedure code and a diagnosis code is fixed to the invoice by the medical billing team.

Charges Applied

• The billing team next creates the claim based on the appropriate coding system for the insurance provider. The claims are usually created within 24 hours or another agreed turnaround time. They are also checked for accuracy before they are sent on to the insurance company.

Follow-Up

• The final stage of the process is a follow-up. The billing team will follow up with insurance companies or whoever is paying the bill until the final settlement is reached.