Simplifying Hospital Billing Format for Client for Facilities

Hospital billing format for client for Facilities

so now we're going to talk about the payment process how that process flows it starts out with a patient visit to the physician who evaluates the patient and they document the conditions this information is then assigned the appropriate diagnosis the icd10 code or the and the CPT treatment code for any treatments they receive the diagnosis and treatment codes are typically documented on a super Bill and sometimes the physician or the provider will check or Circle the diagnosis and treatment and add any modifiers to indicate any modifications to the treatment and then the medical billing Specialists will get involved here this is where they take the Super bill the insurance information and the patient demographic information and input all this information into the practice management software this is sometimes referred to as the medical billing software this is where a claim is then created and uploaded or transmitted to either the insurance company or more typically to the Clearing House continuing with the payment process if there are any problems with the claim the medical billing specialist will follow up and find out what's wrong correct the claim and then resubmit it they may also file an appeal with the insurance payer which could be a written letter or some additional documentation to support the insurance claim and once payments received from the insurance carrier it's accompanied by what's referred to as a remittance advice state statement sometimes referred to as an erra for an abbreviation this information is entered into the practice management software and it's reconciled with the patient account and the claim for that patient visit if there's any co-pays or co- insurance or deductibles patient statement will then be printed and mailed to the P to the patient any unpaid claims require investigation and followup to keep the accounts receivable low for the practice and this is something that the medical Belling specialist is involved in frequently any delinquent patient accounts may require additional statements or letters and coordination with the collection agency if necessary so here's a very simplified diagram of the reimbursement process it starts out when the patient visits Gathering the insurance information and their demographic information and collecting their coopay once that's collected the patient s visits with the provider and the encounter is Doc do umented this documentation is used to assign the appropriate diagnosis and treatment codes and all of this information is then collected and entered into the practice management software this information is then used to create a claim and typically that's an electronic claim uh very occasionally very rarely like less than 5% of the time a paper claim is is created and that's at that point it's just printed out and mailed to the payer electronic claims are then submitted or uploaded to the Clearing House in a batch and these are checked for any errors once they are received or uploaded to the to the Clearing House and if they pass that test pass any checks there they're then transmitted to each individual insurance company or Insurance payer if there are any errors those are corrected and resubmitted to the Clearing House where they're once again submitted to the insurance payer if the claim is okay then it goes to the insurance payer for the adjudication proc process the insurance payer adjudication process is just simply the process that they go through to determine the amount to reimburse to the provider if any adjustments are made these would be in indicated on the electronic remittance advice and the payment would be posted and reconciled in the practice management software uh once insurance payments have been received and reconciled the patient would be build for any remaining uh balance that would be co-insurance or deductible typically and those statements would be sent to the patient and and payment made directly to the provider by the patient for those remaining balances so that completes lesson one a brief description of what medical billing is next in chapter two we'll be talking about some of the more common terms and acronyms used in medical billing