The Medical Billing Process

The medical billing process, beginning with patient registration and moving through charge capture, claim submission, and payment posting. You’ll gain an understanding of the various billing forms, such as CMS-1500 and UB-04, and explore how to create and submit accurate claims. By the end of this guide, you’ll be equipped with the knowledge needed to efficiently manage the billing aspect of healthcare services.

The medical billing process begins with patient registration, where the patient’s personal and insurance information is collected. This step is essential for ensuring accurate billing and reimbursement later on. Once the patient receives treatment, the healthcare provider documents the services provided using standardized codes, such as ICD-10 for diagnoses and CPT for procedures.

After coding, the biller reviews the claim to ensure accuracy and compliance with payer guidelines before submitting it electronically or via paper to the insurance company. The insurer then processes the claim, checking for errors, coverage, and adherence to their policies. They may approve, deny, or request additional information before making a final decision.

Upon receiving the insurer’s response, the medical biller reviews the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) to determine if any adjustments are needed. If the claim is approved, the remaining balance, if any, is billed to the patient. In case of denial or underpayment, the biller investigates the issue, makes necessary corrections, and resubmits the claim. Throughout this process, effective communication between the healthcare provider, biller, and insurance company is vital to ensure timely and accurate reimbursement.”