The medical claims process is used every day in medical facilities all around the world. Chances are you’ve visited a physician and your information has undergone the process. Although medical claims submission may appear complicated, it’s actually relatively straightforward, and comprised of the following steps.
The first step in claims processing is registration. First, a patient will call to set up an appointment, which can be looked at as a type of “pre-registration.” If a patient has already visited the clinic, they normally already have the patient’s insurance information on file. Once a new patient arrives at the facility, they will have to fill out a demographic form, show a form of government-issued photo identification, and hand over their insurance card. The demographic form normally requires information such as the patient’s name, date of birth, address, and Social Security Number.
After a patient leaves the practice, their information is sent to a medical coder. The coder is responsible for translating the information into medical code, which includes their medical history, demographic information, and information about their physician and provider. Afterwards the code is transferred to a medical biller through special software.
Determining Financial Responsibility
After the biller receives a patient’s insurance information, they decide which services are covered by the patient’s insurance plan, or who is financially responsible for which services. Insurance services vary by individual, plan, and company, so the biller needs to review the patient’s information thoroughly to determine their bill. If the patient’s insurance doesn’t cover the services, the biller is responsible for informing the patient that they will have to pay the entirety of the bill.
The medical biller takes the information and turns it into in a paper claim form or inputs it into the correct billing system. These medical billers are responsible for ensuring that the claim form meets all the standards for billing compliance. They then send the form with the costs of the procedures to either a third-party clearinghouse responsible for communicating the form to the payer, or directly to the payer themselves.
The medical claims billing process includes several procedures, but it’s important to understand. By reviewing the different steps, you’ll have a better understanding of how your insurance information and medical services translate into the bill that you have to pay.