Medical Billing and Collections | Sarasota | Accelerated Medical Billing
30 May

Medical Billing and Collections; Steps to the Process

Medical Billing and the collections process is important on both the patient and the medical office sides. Billing is an important aspect of the medical field that can seem complicated at first. Here we will break down the main steps throughout medical billing and collection in Sarasota. They include registering a patient, to medical billing to debt collections.

Did you know, 30% of the average healthcare bill now comes from the patient’s pocket? 90% of patients felt it was important to know their payment responsibility upfront

Steps in Medical Billing and Collections in Sarasota 

1. Registering Patients

Providing a patient with adequate care from start to finish requires having patient information on file. This ensures that medical professionals have a full picture. Every patient’s information is kept for billing and booking purposes.

When registering a patient, they must provide personal and insurance information to the provider. This ensures they are eligible to receive services from the medical service provider.

2. Determine Financial Responsibility

Medical Billing and Collections determine the responsibility. Are the services rendered covered by the patient’s medical insurance policy? Whether it is complete, partial or no coverage, this step determines who received and pays the medical bill. Clear communication within this step is important so that bills are paid properly and on time by the right payer.

Are the services rendered covered by the patient’s medical insurance policy?

3. Patient Check-In and Check-Out

When a patient enters or leaves the medical office, it’s important for each to be logged. During check-out, patients may have to pay co-pay at that very moment, especially when insurance policies have already been sorted out.

Once a patient leaves the office, the information from the visit is sent to a medical services coder. The coder then compiles what is called a ‘superbill.’ A superbill contains all relevant information for the next steps in the medical billing and collections process. These include name of the provider, name of physician, name of patient, procedures performed, codes for the diagnosis and procedure, and other medical information.

4. Claims and Compliance

Once the medical bill has been coded, a claim is prepared and sent to the patient’s insurance provider. At this stage, a biller won’t send the full cost to the insurance provider. Instead, the amount they expect the payer to pay according to the policy with the patient and the provider will be outlined on the claim.

When a claim is made, it’s important that the biller ensures that the coding, services, pricing and format are all correct.

5. Submitting Claims

Submitting a medical claim takes a little more than simply sending off an email. Instead, most payers require claims to be submitted in very specific formats. While a medical office can do this themselves, it’s quite common for a medical office to utilize a third-party organization or company. Known as a clearinghouse, they receive and reformat claims from billers and then transmit them to payers as they are required.

6. Monitoring Adjudication

Once a claim is submitted, the payer responds. At this point in the medical billing and collections process, a payer will respond to the claim and confirm whether the services fall within the contract with the patient.

Rejection occurs at this point possibly due to a lack of coverage, or incorrect coding or formatting. A payer will follow-up when adjudication is complete with a report to the biller. The report details what and how much of the claim they are willing to pay and why.

7. Generate Patient Statements

Once the payer hears a response, the medical office must provide a statement to the patient. This confirms which payer is responsible for payment. This person will also be held accountable for any collections.

8. Medical Billing: Payments and Collections

Last but not least, managing payments is the final step in medical billing and collections in Sarasota. Billers are in charge of timely and accurate medical billing and collections. Accelerated Medical Billing follows all these processes, if this is something that you are interested in than hire the best. Call us today at (727) 781-8460 or contact us here.