What Are Steps of Medical Billing Process

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Hospitals and healthcare facilities face many challenges when it comes to settling insurance payments. Payments are considered made when patients present their insurance information at the hospital reception desk. However, the hospital or medical facility will not receive the final payment. Until the insurance company pays the claim. Our healthcare billing services allow hospitals to take a back seat at various steps in the process. So, lets talk about steps of medical billing process.n

Medical Billing Process

nLike medical coding, medical billing may seem big and complicated. But it’s a process that consists of eight simple steps. These steps include registration, determining financial responsibility for a visit, patient check-in, and check-out. Reviewing code compliance and billing, preparing and transferring claims, tracking payer decisions, and generating patient statements. Or bills, matching patient payments, and organising collections. Keep in mind that there is a difference between “front of house” and “back of house” responsibilities when it comes to healthcare billing.nnAlso Check:n



nThe purpose of medical billing is to make sure that the provider receives fair payment for services offered. Payment should consider the services performed and should be received promptly.n

Revenue Cycle Management

nIn addition to collecting the data and sending the claim form to the payers. It is the responsibility of the medical billing provider to ensure that the data is accurate. And that the claim has been properly assessed. Payments originating from either the patient or the insurance payer are posted to the claim through the health biller. Any remaining balances are then either written off, adjusted, or collected.n

Ten Steps of Medical Billing Process 

nThe ten steps in the medical billing process are as follows:n


  •   Financial Responsibility.
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  •   Claims Submission.
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  •   Monitoring Coding and Billing Compliance.
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  •   Verification of Insurance Information.
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  •   Record the Resources Received by the Patients.
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  •   Process of Payer Adjudication.
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  •   Charge Entry.
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  •   Account Receivable.
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  •   Patients Check-In and Check-Out.
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  •   Peruse Payment.
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Steps of Medical Billing Process

nHere are;n

Financial Responsibility:

nThe second step in the process is determining the financial responsibility for the visit. This means looking at the patient’s insurance details to see what procedures. And services to be provided during the visit are covered. If some methods or services will not be covered. The patient is advised that they will be financially responsible for these costs.n

Claims Submission:

nOnce the application has been reviewed for accuracy and compliance, the next step is submission. In most cases, the claim will be submitted electronically to a clearinghouse. Which is a third-party company that acts as an intermediary between healthcare providers and health insurance companies. The exception to this rule is high-volume payers such as Medicaid. Which will accept claims directly from healthcare providers.n

Monitoring Coding and Billing Compliance:

nThe Superbill is then entered into medical billing software or a paper claim form by the medical biller. The biller also reviews codes generated by the coder and ensures claims meet compliance standards. Suggestions set by the Health Insurance Portability and Accountability Act (HIPAA). And the Office of Inspector General is usually followed. So, this is also one of good steps of medical billing process.n

Verification of Insurance Information:

nInsurance eligibility and information must be verified at each appointment, even for regular patients. This is because information changes over time. Changes to insurance information may affect benefits as well as eligibility information.n

Record the Services Received by the Patients:

nA health care provider, such as a nurse or doctor, examines the patient, then makes a diagnosis or provides other needed services. The healthcare worker then records the obtained data in the patient’s Electronic Record.n

Process of Payer Adjudication:

nPayer review is a process where the payer evaluates the legitimacy of a medical claim and either accepts it. Rejects (in case of any errors), or rejects (in case a medical facility not listed in the insurance is accounted for in the bill). This is done within the rules and regulations agreed upon in advance between the patient and the payer. To avoid any complications in this process. Healthcare facilities must create clean claims in the first place.n

Charge Entry:

nThe cost incurred to provide the service is added to the amount calculated by the medical coder. This is the first step in the preparation of the claim form, which is submitted to the insurance company. And without a certain and exact amount, payment cannot be collected. The application form is thoroughly checked to ensure that the correct amount is given. As this has resulted in either a reduced payment or a complete rejection of the application. Medical application forms usually providen


  •   Information for the patient.
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  •   Medical history of the patient.
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  •   Procedures provided with the correct codes.
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  •   National Provider Index (NPI) number and insurance supplier.
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  •   Instead of a service code.
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 Account Receivable:

nClaims denied even after rectification is consistently followed up with the insurance company. And additional information is collected that caused the denial of payment. Insurance coding, medical coding, and billing are shared so you can see any errors. This is also one of top steps of medical billing process.n

Patients Check-In and Check-Out:

nPatient check-ins and check-outs are relatively simple front-of-house procedures. When the patient arrives, they will be asked to fill out some forms (if this is their first visit to the provider). Or to confirm the information the doctor has on file (if this is not the first time the patient has visited the provider). In addition to a valid insurance card, the patient will also need to provide some form of official identification. Such as a driver’s licence or passport.n

Peruse Payment:

nIf your claim has been approved, you will seek reimbursement from the payer. Keep in mind that it can take a long time between claim approval and reimbursement. Properly keeping track of your receivables will help you identify which receivables have gone too long without being paid. You should monitor these claims until you receive payment.n


nSteps of medical billing process of submitting health insurance claims for a patient to various health insurance payers. To obtain reimbursement for services provided at a medical facility. The collection process in medical billing must be curated with immense care and attention. All steps of this process are equally important and none of them can be skipped. Billing and collection practices in a medical practice make or break a healthcare organisation. This is why physicians hire professionals to handle medical billing processes.

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