Medical billing experts perform various steps in the healthcare billing process to make sure that healthcare professionals get reimbursement for the services they provide. The process may take days, weeks, and even months in different circumstances. In this blog, we will discuss the payment process and claim cycle in medical billing.
Payment Process & Claim Cycle in Medical Billing
The medical billing payment process involves a few essential steps. In the first step, the patient sees a physician. The physician writes down his observations as well as the treatment plan after evaluating the patient. Then, he assigns the appropriate CPT treatment and ICD-10 diagnosis codes. He also writes down code modifiers when necessary.
In the next step, they document diagnosis and treatment codes on a Superbill. A few physicians will circle or check the treatment and diagnosis codes on that Superbill. Most patient visits include almost identical codes.
In the third step, we see the involvement of a medical billing expert. He gets the insurance and Superbill information and enters it into the medical billing or practice management software. Using this information, they create a medical claim. E-claims are uploaded or transmitted to the clearinghouse or an insurance company.
Next, a medical billing expert checks the claim for possible errors and corrects it (if found any issues). The expert enters the payment received into the billing software. He will create the patient statement containing patient responsibilities (if any), like co-insurance or co-pays. After that, he will print and mail the patient statement.
If there are any unpaid claims, the expert will investigate them. He will keep an eye on those claims to make sure that accounts receivables stay low. Delinquent accounts of the patient may need extra letters or information for collecting unpaid claims. This is how the payment process and claim cycle in medical billing works.
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