What Are the Key Steps In Physician Billing Process?

Revenue collections play a critical role to help run medical businesses successfully. May it be a healthcare group or an individual medical practice, without ensuring timely reimbursements, their business would collapse. Physician billing process is carried out for those physicians having an individual practice or for the ones who are out-of-network with the patient’s insurance provider. It helps maximise revenues for the physicians as well as ensure the revenue inflow is on time. 

The following are the key steps in the physician billing process: 

  • Patient Registration

In this step, patient demographic information is collected. The details that are collected include the reason for the patient’s need for medical services, patient’s name, address, insurance payer, insurance policy number and such. This step helps the medical practice file all the collected information about the patient and their insurance provider to help proceed with the further steps in the physician billing process. 

  • Verifying Patient Insurance Eligibility

The collected patient information must be double checked to ensure a smooth physician billing process. This includes verification of the patient’s insurance information such as the name of the insurance provider, the medical services covered in the insurance plan and its validity etc. This step is essential to ensure that the insurance information collected from the patient is authentic. Failing to re-check such insurance details can lead to issues during medical coding and claims submission, since claims with inaccurate information are denied. 

  • Medical Coding

After the patient gets treated by the physician, the information regarding their diagnosis and medical procedures must be translated into accurate alphanumerical codes. This translation must be carried out according to the coding classification systems such as ICD, CPT and HCPCS to name a few. These coding systems make it simple for storing, retrieving and analysing patient medical information through accurate codes that signify different ailments, procedures, diagnosis etc. Once the patient’s personal, insurance and medical information is coded with precision by the medical coders, the claims filing process begins. 

  • Generating Medical Claims

Medical billers generate medical claims either manually or electronically. Electronic claim generation is done using software, which ensure information accuracy and enable an easier and faster charge entry. Once the necessary information is filled into the claim, it goes through multiple audits to help avoid claim denials. 

  • Filing Claims

This step is also known as claims submission where the claims generated are submitted to the insurance provider. This submission of claims must be carried out within a specified deadline to enable the insurance company to receive and process it since late claim submission also causes claim denials. Once the patient claim is successfully submitted and received by the insurance provider, they proceed to cover the patient costs for medical services according to the patient’s insurance coverage plan. 

  • Payment Posting

Once the insurance provider completes their role by covering patient medical expenses according to the insurance coverage plan, the balance payment is automatically considered to be covered by the patient. In this step, the payments covered by the insurance provider along with the balance payments to be paid are posted in the patient accounts, after which the patient can proceed to pay their balances.

Finally, the medical biller’s follow-up with the insurance providers and patients to secure complete payments owed to the medical practice. In this way, the physician billing process helps physicians gain maximised revenues for their medical practice.