Billing Process
01.
Patient Registration:
Patient information is gathered, encompassing demographic details, insurance information, and contact data.
02.
Patient Visit:
Medical services are provided to the patient, and comprehensive medical records are established, documenting diagnoses and procedures performed.
03.
Coding:
Medical coders assign specific codes to diagnoses, procedures, and medical services, which are utilized for communication with insurance companies.
04.
Claim Preparation:
A medical claim is generated, incorporating patient information, insurance details, and coded services.
05.
Claim Submission:
The claim is submitted electronically to the patient’s insurance company.
06.
Claim Adjudication
The insurance company reviews the claim for accuracy and completeness, determining the payment amount based on the patient’s insurance coverage and the provider’s contracted rates.
07.
Payment or Denial:
If the claim is approved, payment is issued to the medical provider. If the claim is denied, the provider may need to resubmit it or file an appeal.
08.
Patient Billing:
Patients may be responsible for co-payments, deductibles, or any amounts not covered by insurance. Invoices are sent to patients, and follow-up is conducted to collect any outstanding balances.