The Medical Billing Process - Step By Step

Detailed medical billing instructions, with screenshots.

1. Patient Registration (IF you are on the front lines)

Greet the patient upon arrival.

If the patient is new or hasn't been in for quite a while, give them a registration form (This contains all the demographic information needed in the next few steps).

Give the patient the HIPAA Privacy notice after the office policies in regards to Protected Health Information have been explained (this will need to be signed by the patient).

Make a copy of the Patient's Insurance Card (front and back).

Create a new patient account or update an existing account using the information provided by the registration form.

Create a new encounter form and attach it to the patient file (This is usually done in offices that are still using paper methods).

2. Insurance Verification/Authorization

This is to be done before the patient is seen by the doctor!

You need the patient's name, the policy holder's name and date of birth, group number, and the policy number. With the exception of the patient's name (if they are not the policy holder) this information is located on the insurance card.

Call the number for the insurance provider; this information is located on the back of the patient's insurance card. Ask to verify medical coverage.

The representative will ask you a series of questions. Provide the information required. Insurance verification information will be provided. This may include such things as the policy's effective dates, co-insurance, deductibles, etc.

Finally, request the information to be emailed or faxed to your office. Place a copy in the patient's medical records for future use.

You can also verify insurance information using the office Practice Management System.

Start by opening the Online Eligibility button from the main menu of the PMS. Open the patient's account. The patient's information is already entered for you. Check for any errors and make sure the correct insurance type (primary, secondary, or other) is selected.

If everything is correct, click the Send to Payer button to begin the verification process. When the transfer is complete, click the view button to see the results.

The information provided by the Online Eligibility Report includes the Insurance Provider name, Policyholder name, status (hopefully it states ELIGIBLE), patient's name, patient's DOB, patient's gender, office co-pay/deductible, account number, and the healthcare provider's name.

Click the Save button to place it in the patient file and close the window.

3. Encounter Form

The encounter form contains both procedural and diagnosis codes which correspond with the patient's examination. It is filled out by the physician after the patient encounter.

Make sure the encounter form is filled out completely. Identify any additional notes the physician has made.

Parts of the encounter form:

Patient name - the name of the patient receiving the services.
Reference number -identifies and matches documentation of services posted to the PMS.
Place of service - where the encounter took place - office, hospital, homecare.
Date of service - date of the patient encounter.
Procedure list - lists the practice's most common procedures and their codes.
Miscellaneous - where any procedures not listed can be written in.
Amount paid - deductibles and copays made by the patient at the time of the encounter.
Diagnoses not listed - are where any unlisted diagnosis are filled in.
Diagnoses list - the physician places a "1," "2," or "3" on the line to the right of the diagnosis code to represent the primary, secondary, and tertiary diagnoses.
Advanced Beneficiary Notice (ABN) - lets patients know when Medicare is likely to deny payment for certain services.
Doctor's Signature - signature to confirm the information the encounter form contains.
Patient return - indication of when the patient should be seen again.
Practice and physician information - practice demographic information and EIN number.