Patient Registration: This is the first step where patient demographic and insurance information are collected and entered into the medical billing system.
Insurance Verification: The insurance information provided by the patient is verified with the insurance company to ensure that the patient is eligible for coverage.
Medical Coding: The medical services and procedures provided to the patient are converted into standardized codes, which are used to create a medical claim.
Charge Entry: The charges for the services provided are entered into the medical billing system.
Claim Submission: The medical claim is submitted electronically or by mail to the patient’s insurance company.
Claim Scrubbing: The medical claim is reviewed for errors, inaccuracies, and missing information to ensure it meets the insurance company’s standards.
Insurance Adjudication: The insurance company reviews the claim and determines the payment amount based on the patient’s insurance plan and the services provided.
Payment Posting: The payment received from the insurance company is posted in the medical billing system.
Patient Statement: If there is a balance due after insurance payment, a statement is sent to the patient for payment.
Follow-up and Collections: Any unpaid balances are followed up with the patient or insurance company, and collections processes are initiated as necessary.These 10 steps are the foundation of the medical billing process and must be performed accurately and efficiently to ensure timely payment for healthcare services provided.