What are the 10 steps in the medical billing process?

What are the 10 steps in the medical billing process?
Medical billing is a complex field that’s composed of a series of steps to ensure timely claim submission and reimbursements. However, some practices tend to get lost along the way as they try to juggle revenue cycle management with patient care.
So, for this post, we will outline the 10 crucial steps to medical billing, how you can streamline them, and the mistakes you should avoid. Read and see if your practice is missing out on important processes!

10 steps in the medical billing process

What are the 10 steps in the medical billing process?
If you’ve been in the practice for some time, these medical billing cycle steps are nothing new. Still, revisiting these steps can help you identify where ‘choke points’ happen in your revenue cycle. With that, let’s take a quick rundown of these steps:

1.  Patient Registration

The first step in the medical billing process steps is patient registration. During this step, you’ll collect the patient’s demographic and insurance information. This information includes the patient’s name, address, contact details, date of birth, insurance policy number, and any other relevant information. Overall, patient registration is essential to ensure accurate identification and to verify insurance coverage early on.

2.  Insurance Verification

Once you collected the patient’s information, you proceed with insurance verification. This step involves contacting the patient’s insurance company to confirm their eligibility and coverage details. For this, we will check whether the patient’s insurance policy is active and if it covers the specific services being provided. Also, insurance verification helps determine if any pre-authorization is required before proceeding with the treatment or procedure.

3.  Charge Entry

After the patient’s visit or procedure is completed, you’ll record the services you provided together with associated charges. This step is known as charge entry. It involves meticulous documentation of all the services rendered, including medical coding of any additional services or supplies used during the treatment.
Take note that accurate charge entry ensures your services are properly coded for billing purposes. It also prevents the risk downcoding, an error that can bring legal problems to your practice.

4.  Claims Submission

Once the charges are entered into the system, the next step is to submit the insurance claim to the patient’s insurance company. This can also be government payers like Medicaid and Medicare.
For this, claims can be submitted electronically or through paper submission, though the former is now a popular option. Before sending, make sure that the claim includes all relevant information, such as patient details, services provided, diagnosis codes, procedure codes, and associated charges.
The good thing is that our medical practice billing services can handle claims submissions for your practice. Our specialists will ensure that your claims are error-free for fast reimbursements.

5.  Claims Processing

Now that the ball is on the payer’s side, all you have to do is wait. Payers have to review your claims for accuracy and completeness. They check for any missing or incorrect information that could lead to claim denials or delays in payment.
Also, the insurance company verifies if the services you provided are covered under the patient’s insurance policy. During claims processing, the insurance company may request additional documentation or clarification from your medical organization.

6.  Adjudication

Once the insurance company completes its review of your claim, it proceeds with adjudication. Adjudication is the process of determining the amount that will be paid for the services you provide based on the patient’s insurance plan.
Aside from that, the insurance company applies deductibles, co-pays, and co-insurance as per the patient’s policy terms. They also calculate the allowable amount based on their fee schedule and any contractual agreements with the healthcare provider.

7.  Payment Posting

After adjudication, the insurance company will send a payment remittance advice to your practice. This document contains details of the payment made by the insurance company for the services you rendered.
During payment posting, your staff will record and post this payment to the patient’s account. The posting reflects the amount paid by the insurance company and any remaining balance that needs to be addressed to the patient later.

8.  Patient Billing

If there’s a remaining balance after insurance payment, the next step for you is to generate a patient bill. This bill includes details of services rendered, insurance payments made, and any outstanding amount that the patient is responsible for.
Moreover, patient billing involves creating an itemized statement that clearly presents all charges and payments related to the patient’s visit or procedure. If this sounds like too much for your practice, you can partner with medical billing services like ours to handle the process.
With our professional medical billing services, you can free up your staff from the overwhelming process of handling A/Rs.

9.  Patient Payment Collection

Once the patient receives their bill, they are responsible for paying any outstanding balance to your healthcare practice. Take note that patient payment collection involves communicating with patients regarding their financial responsibility and providing them with payment options.
This step may include sending invoices and discussing payment plans or options. Also, it may need to coordinate with patients to settle outstanding balances. Our medical collection services can handle this step for you so you can focus on patient care instead of chasing payments.

10. Denial Management and Appeals

In some cases, insurance companies may deny or underpay your claims. This is where denial management comes in.
Denial management and appeals refer to the process of identifying the reasons why your claims were denied. From there, you can take appropriate actions to address them.
Overall, this step involves reviewing denied claims and resubmitting corrected claims with additional documentation. You may also need to contact the insurance company for clarification or resolution. The good thing is that a medical billing company like MFS can take over this responsibility on your behalf.

Strategies to streamline healthcare billing process flow

What are the 10 steps in the medical billing process?
Medical billing involves a myriad of steps that require accuracy and attention to detail. To ensure that your system is calibrated for steady revenue, here are some strategies you can take:

1.  Implement Electronic Health Records (EHR) System

Transitioning from paper-based records to an electronic health records (EHR) system can significantly streamline your healthcare billing process. EHR systems enable your practice to capture, store, and manage patient information electronically. This includes demographics, medical history, diagnoses, medications, and treatment plans.
By integrating billing functionalities within the EHR system, you can automate charge capture, coding, and claims submission. This will reduce manual errors and enhance billing accuracy.

2.  Standardize Documentation and Coding Practices

Standardizing your documentation and coding practices is crucial for efficient medical billing. Healthcare providers like you should establish clear guidelines for documenting patient encounters and procedures to ensure consistent and accurate coding. Also, training staff can minimize coding errors, improve claim accuracy, and expedite the billing process.

3.  Utilize Revenue Cycle Management (RCM) Software

Investing in robust revenue cycle management (RCM) software can streamline your billing processes. You can do this by automating tasks such as claims submission, payment posting, denial management, and medical billing reports.
Also, RCM software provides real-time visibility into the revenue cycle. This allows healthcare providers to track claims status, identify bottlenecks, and optimize billing workflows for improved efficiency.

4.  Leverage Data Analytics for Performance Insights

You can also harness the power of data analytics to get valuable insights into your billing process. This includes analyzing key performance indicators (KPIs) such as claim acceptance rates, denial rates, days in accounts receivable (AR), and average reimbursement time. Through this, you can identify areas for improvement and implement targeted strategies to enhance billing efficiency.

5.  Enhance Patient Eligibility Verification

Another thing you can do is improve patient eligibility verification processes. This way, you can prevent claim denials and reduce delays in reimbursement. You should leverage technology to automate insurance verification and confirm patient coverage details, co-pays, and deductibles in real-time. This way, you can ensure you’re your rendered services are covered by the patient’s insurance plan.

6.  Streamline Charge Capture and Entry

Efficient charge capture and entry processes are essential for accurate and timely billing. With this, you should implement automated systems for capturing charges at the point of care and integrating them directly into your billing system. By doing this, you can reduce manual data entry errors and speed up claims submission.

7.  Optimize Claims Denial Management

Developing a robust claims denial management strategy is critical to minimizing revenue loss and improving cash flow in your practice. This is why your practice should establish clear workflows for identifying, appealing, and resolving denied claims promptly. You can also analyze denial trends and implement corrective measures to mitigate recurring denials and optimize reimbursement.

8.  Implement Clear Communication with Patients

Effective communication with patients regarding their financial responsibilities can streamline your billing process. Your healthcare organization should educate patients about insurance coverage, co-pays, deductibles, and out-of-pocket expenses upfront to avoid confusion and delays in payment collection.

9.  Embrace Automation for Payment Posting

Automating your payment posting processes can expedite the reconciliation of insurance payments and patient balances. Also, you can leverage electronic remittance advice (ERA) and auto-posting capabilities within the billing system to improve the accuracy of your financial reporting.

10. Partner with a Medical Billing Service

Partnering with medical billing outsourcing services will give you access to advanced billing technology and dedicated resources for optimizing the billing process flow.
Aside from that, outsourcing your medical billing and coding to a trusted company like MFS will reduce your administrative burdens. Also, our healthcare billing solutions will ensure your compliance with ever-changing regulations.

Common mistakes to avoid

Medical billing is the lifeblood of every healthcare practice. Errors or mistakes can easily cost your organization substantial revenue. This is why it’s crucial for your practice to avoid these common mistakes:

1.  Lack of Regular Performance Analysis and Monitoring

Neglecting to analyze your key performance indicators (KPIs) and can result in missed opportunities for process improvement. Also, your healthcare practice should establish a system for tracking metrics such as average reimbursement time, claim acceptance rates, and accounts receivable turnover.
Through this, your organization can identify areas for optimization and implement targeted strategies to enhance billing performance.

2.  Failure to Address Staff Burnout and Turnover

Aside from the nitty-gritty of the medical billing process, it’s also important to address possible staff burnout. It’s because high staff turnover and burnout can negatively impact the continuity and efficiency of your billing process.
To prevent this from happening, you should consider hiring medical billing and coding services. This way, you can remove the billing tasks from your staff so they can focus on other matters in your practice. And in case someone resigns from your team, your cash flow will not suffer since there’s a separate pool of experts handling it for you.

3.  Inefficient Coordination Between Clinical and Billing Staff

Lack of effective communication and coordination between clinical and billing staff can lead to billing errors and delays. For this, your healthcare practice should collaborate with your billing team to ensure accurate documentation, coding, and charge capture. Also, clear communication channels and interdisciplinary training can enhance coordination and streamline the billing process flow.

4.  Ignoring Patient Feedback and Complaints

Disregarding patient feedback and complaints about the billing process can result in dissatisfaction and strained patient-provider relationships. With this, you should actively seek patient input regarding their billing experiences, address concerns promptly, and implement improvements based on patient feedback.
Or better yet, you can partner with top medical billing companies to handle patient collections for your practice. They will serve as an extension of your organization, which is skilled in handling patient concerns.

5.  Inadequate Contingency Planning for Revenue Disruptions

Not having contingency plans in place to address potential revenue disruptions, such as system outages or staffing shortages, can lead to operational challenges. Your healthcare practice should develop contingency plans to mitigate the impact of unforeseen events on the billing process. This may include backup systems and establishing protocols for maintaining billing operations during disruptions.

6.  Overlooking Payer-Specific Requirements

Failing to comply with payer requirements can result in claim denials and payment delays. Take note that different insurance payers may have specific coding, documentation, and billing guidelines that you must follow.
At the same time, you should stay updated on any new credentialing process requirements that may affect your practice.

7.  Trying to manage everything in-house

While managing the medical billing process in-house is not a bad thing, it’s only as good as the skills of your staff. It’s important to recognize that relying solely on internal resources may limit your ability to keep pace with the demands of medical billing.
With this, you should consider partnering with the best medical billing company. This way, your practice can easily scale and enhance the entire revenue cycle without putting too much work on your in-house team.

Boost your medical billing procedures with the help of MFS

The medical billing process is complicated, technical, and often overwhelming for busy healthcare practices. So, instead of spending time handling paperwork, collections, and follow-ups, you can partner with Med Financial Solutions for a hassle-free medical billing experience.
If you need help with your medical billing process or if you want to learn how we can help your practice, schedule a consultation with us today!
Scroll to Top