Medical billing is the process of generating and submitting health insurance claims or patient bills to be reimbursed for healthcare services. These claims are presented to insurance payers and patients for the purpose of receiving payment for medical services rendered.
Medical coding and billing are separate but related processes. Medical coders review a patient's chart during their visit, extract billable information, and translate that information into standardized codes that appear on the bill. Medical billers collect multiple types of data for presentation on the CMS 1500 Form (for physician billing) or the UB-04 Form (for hospital and facility billing).
The Stages of the Medical Billing Process
The medical billing process comprises two main stages, known as the front end and the back end. Front-end billing occurs pre-service (before patients see the physician). This stage typically involves front-of-office staff and captures all patient-facing activities.
Back-end billing occurs after the physician has seen the patient. Once a medical coder completes the coding process, back-end activities can begin. These steps are not patient-facing and involve the claims management and reimbursement processes.
Front-End Medical Billing
Front-end medical billing requires staff to be familiar with their healthcare organization’s payors. They must also have knowledge of insurance eligibility requirements, which payors require pre-authorization of services and any filing deadlines.
Processing of insurance claims begins when a patient schedules a clinic appointment or registers at a hospital. Front-office staff will obtain demographic and insurance information, which the patient may provide via a registration form.
To ensure payment for services, front-office staff must also confirm that a patient’s healthcare plan covers the services that will be performed.
Back-End Medical Billing
Medical billers must maintain communication with physicians to obtain information about a patient encounter or to verify diagnoses. A medical biller must also be familiar with CPT, HCPCS Level II, and ICD-10 codes and know how to read medical records.
Charge entry staff will use an encounter form to see what procedures were performed and why they were performed. The staff will then enter charges for the services into a practice management system.
After charge entry, medical billers will go through the claim generation and claim scrubbing processes. Claim generation is the process of compiling charges and codes to prepare an insurance claim. Claim scrubbing verifies that all procedures, diagnoses, and coding are accurate. Medical billers will often use claim scrubbing software to help identify and correct any errors.
How TempDev Can Help With Medical Billing
TempDev’s team of experienced consultants, developers, and trainers can enhance accessibility by customizing features and templates. This will give you and your patients more control over data and better transparency.
As part of our streamlining process, we will help you implement the Patient Portal, API, and other tools to better support safety, patient engagement, and security. TempDev offers the comprehensive resources you need to ensure compliance from dashboards and automation to workflow redesign.
Contact us here or call 1.888.TEMP.DEV to ensure you're optimizing your medical billing cycle to its greatest potential.
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