Explore Medical Billing & Coding Tips within your Practice

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     Medical billing is an occupation that requires knowledge of coding and techniques for billing. In the ever-changing world of health care, a billing specialist works hard to keep up with coding requirements and changes. The billing process begins before the patient comes into the office, with verification and pre-approval from her insurance company, and continues long after she is gone.

     
     
   
   
   
   

   Pre-Approval

   
   
   
   
   • When a patient sets up an appointment, it is important to get his payment or insurance information up front. If the patient is paying cash, it is unnecessary to do anything else, but if the patient has insurance, verification and pre-approval are important. This consists of calling the insurance company and requesting the patient's policy information, as well as asking if he requires any further authorization or a referral before he can be treated. In addition, the insurance company will tell you the amount of the co-pay or deductible the patient is required to pay during his visit.
   
   
   
   

   Coding

   
   
   
   
   • Correct coding and use of the Current Procedural Technology (CPT) codes that an insurance company uses to pay claims is important. If the correct code is not listed on the form, the insurance company will return the claim with no payment. This can delay payment because the form will have to be corrected and refiled as a "corrected claim." This slows down the billing process.
   
   
   
   

   Patient Billing

   
   
   
   
   • An insurance company and a physician may have an agreement for an accepted price on a procedure. After the insurance company pays and the physician takes the adjustment, a patient may be required to pay. If a procedure is not covered or the patient owes a balance after the insurance company pays its share, the balance is billed to the patient. Send a statement to the patient as soon as you receive payment from the insurance company. This allows the patient ample time to contact the billing department or insurance company with any questions she may have.
   
   
   
   

   Collections

   
   
   
   
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     If a patient fails to pay the amount due, the next step is collections. Collections involves working with the patient to set up payments or using other means such as a collection agency or wage garnishment to receive payment. Start by contacting the patient by telephone to make sure there is not a misunderstanding (i.e., the bill was lost in the mail). Offer to set up a payment plan to enable the patient to take care of the bill. If this doesn't work, send the patient a certified letter demanding payment. If you still have no response from the patient, you may turn the bill over to a collection agency.