Pre-registration
The medical biller or medical coder inputs the patients insurance information into the database and makes a copy the patients insurance card.
2: Verify insurance information
If it’s a new patient or a new insurance policy, the health claims specialist talks with the patient to be sure the medical practice takes the insurance, and to be sure the patient understands his or her coverage.
3: Record the services the patient received
the doctor, nurse, or other healthcare provider examines the patient, provides a diagnosis, and performs any necessary services. The healthcare provider then records this information in the patients EHR.
4: Collect patient payment
At time of check-in or check-out, the patient will pay a co-pay, co-insurance, …show more content…
This has to be done accurately to ensure that the provider is paid correctly.
6: Submit a claim
After the codes and patient payments have been documented, the medical biller or coder can generate the insurance claim. It is then submitted to the insurance company, Medicaid, or Medicare, depending on how the patient is covered.
7: Receive and post payment
If the claim has been submitted correctly, the payer will send payment to the medical practice, and the medical biller will post the payment to the practice’s account. Medical billers and coders are sometimes responsible for tracking down payments that are late, or fixing claims that may have been submitted with errors.
One of the concerns of the medical biller and coder is accuracy. Inaccurate coding can lead to unpaid claims and late revenue for the medical service provider. Medical coders need to be detail-oriented, organized, and analytical, so that they can use a critical eye toward the procedures, diagnoses, coding, and insurance
The medical biller or medical coder inputs the patients insurance information into the database and makes a copy the patients insurance card.
2: Verify insurance information
If it’s a new patient or a new insurance policy, the health claims specialist talks with the patient to be sure the medical practice takes the insurance, and to be sure the patient understands his or her coverage.
3: Record the services the patient received
the doctor, nurse, or other healthcare provider examines the patient, provides a diagnosis, and performs any necessary services. The healthcare provider then records this information in the patients EHR.
4: Collect patient payment
At time of check-in or check-out, the patient will pay a co-pay, co-insurance, …show more content…
This has to be done accurately to ensure that the provider is paid correctly.
6: Submit a claim
After the codes and patient payments have been documented, the medical biller or coder can generate the insurance claim. It is then submitted to the insurance company, Medicaid, or Medicare, depending on how the patient is covered.
7: Receive and post payment
If the claim has been submitted correctly, the payer will send payment to the medical practice, and the medical biller will post the payment to the practice’s account. Medical billers and coders are sometimes responsible for tracking down payments that are late, or fixing claims that may have been submitted with errors.
One of the concerns of the medical biller and coder is accuracy. Inaccurate coding can lead to unpaid claims and late revenue for the medical service provider. Medical coders need to be detail-oriented, organized, and analytical, so that they can use a critical eye toward the procedures, diagnoses, coding, and insurance