The medical billing process and all of the functions that pertain to it are the responsibilities of the medical insurance specialist. It addresses all tasks that will be performed by the administrative staff members during the medical billing process. These functions are typically handled by front office staff members such as the receptionist (registration) and scheduling.
Here are ten steps that will be explained which are the responsibility of the medical the medical insurance specialist.
Step 1: Preregister patients
* There are two main tasks that are involved when patients are at the preregistration period of their initial visit. These tasks include scheduling and bringing up to date any appointments that they may have.
Step 2: Establish financial responsibility for visits
* This is a very important step because it involves the determining of who is financially responsible for the visit. It also is used to establish what services may be covered under the type of insurance they have, along with payment options plan options if any, and what types may be available to the patient.
Step 3: Check in patients
* This step is used to check in patients, this is also the point at which new patients will provide information about themselves. A complete and detailed demographic review of their medical information will be collected at this time by the front desk. When returning patients arrive, they are asked to review the information and provide changes, if any.
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Step 4: Check out patients
* The check-out procedure follows when the patient is done and ready to leave, once the physician and has given the patient their diagnosis and other procedures are complete. This is also the step in the visit where all expenses of the visit are tallied and the patient is brought to awareness of the amount owed in their ledger.
Step 5: Review coding compliance
* This area is formatted so that all official requirements are met. Meaning all official guidelines that are assigned to the codes will be followed to their standard purpose. Checking for errors when codes are assigned once diagnosis and procedures are selected is critical at this time so the patient will able to understand their charges.
Step 6: Check billing compliance
* Most medical practices have a standard set of fees listed, and each visit is related to a specific procedure code. Although each code is not necessarily billable, there are separate fees associated with each of the codes that are. Knowing the codes and the procedure that goes with it is important so that the correct charges are applied and the guidelines are still being followed.
Step 7: Prepare and transmit claims
* A claim is meant to communicate any information about the patient diagnosis given by their physician, it may also be used for the reimbursement of services that have been rendered. Most practices prepare the claim and send them off electronically.
Step 8: Monitor payer adjudication
* Here all procedures are listed and monitored, and any unpaid charges are explained. The codes on the payment transactions are viewed to make sure they match the on the claim form, and the payment listed for each procedure is correct in accordance to the contract with the payer
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Step 9: General patient statements
* This procedure breaks down what bills will be covered by the insurance plan and what bills are expected to be covered by the patient. It will provide the patient with the service dates for each fee, and when and how much they are expected to pay for the services. Step 10: Follow up patient payments and handle collections
* Patient medical records and financial records are filed and retained in accordance to the medical practice’s policy. They are regularly reviewed and analyzed to see if their financial responsibilities have been met. Federal and State regulations govern what documents are to be kept, and the amount of time.
Reference
Part 1: Chapter 1 Working with Medical Insurance and Billing pp. 16-21
