The process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider is time consuming and complex. However, if you want to enhance your medical practice and are not sure whether your practice has everything smooth and under control, here are the steps for the Features of a Practice Management System
1. Patient Appointment
The process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider is time consuming and complex. However, if you want to enhance your medical practice and are not sure whether your practice has everything smooth and under control, here are the steps for the effective medical billing
2. Insurance Eligibility and Verification
Verification of insurance and eligibility before appointment is important that even regular patients need to verify their insurance information and eligibility before every appointment. Insurance information can change at any time. Therefore, you need to ask patients before every visit if their insurance information has changed. A change in insurance information can also impact benefit and authorization information, so it is always necessary to double-check.
3. Medical Coding
The correct coding of claims is very important in order to inform the insurance payer of what exactly the patient is being treated for and also specify the method of treatment the patient is undergoing. It is crucial to use the correct diagnosis codes for the proper description of the patient’s symptoms and illnesses and the correct procedure codes to describe the patient’s method of treatment. Use accurate CPT and HCPCS code modifiers to provide information about the service or procedure that are performed. The insurance payer can only make an accurate assessment if they are provided with the correct codes and modifiers.
4. Charge Entry
It means entering the charges for services that the patient received. The charge entry also includes the proper linking of medical codes to services and procedures performed during the patient’s visit.
5. Claim Submission
When the claim is properly completed, it should be submitted to the insurance payer for payment. Medical billers need to have access to the information they need about the insurance payer as there are so many variables for each insurance payer to examine and decide how and when to submit a claim. While most insurance companies follow a standard set of guidelines for billing. Nonetheless, there are some players who have a separate way of doing things. Certain aspects of medical billing are payer-specific, so it is important to check with each payer to make sure you are accurately following their guidelines for claims submission.