Although everyone in America has been to a hospital at least once by the time they’re thirty, many people don’t understand how the process continues after they leave. The billing process is one that can frustrate some, but once it’s explained, it makes sense.
This step is the natural part. While the patient is in the medical office, they accrue charges. These can range from blood tests to surgery, to something as simple as an eye exam. Doctors and nurses write what services get rendered and keep track of it on the patient’s paperwork. The patient will usually pay a deductible before they leave, and then the real process begins.
Verification of Insurance
If the office didn’t verify insurance before the services got rendered, this is the time it gets done. This duty can get completed by many people in the office and is simple. Contacting the insurance provider to ensure the medical firm is covered can be done by phone- but many have an automated service online as well. If the patient’s insurance is proper, they’ll ask for credentialing- if it’s not, the patient will be liable for the next few steps.
This step is when an insurance company will check to be sure the doctor is supposed to be undertaking the work. The credentialing process in medical billing is to ensure that there’s no dupe or ploy to trick the insurance company into paying for a specialist when there’s just a general practitioner on hand.
A medical coder is an employee who takes the appointment information the doctors and nurses wrote down about the visit and translates it into code for billing. This part of the invoice is essential because it allows the firm to follow HIPAA guidelines and stay safe legally.
The medical biller works hand in hand with the medical coder, using the code to itemize a bill for the patient and their insurance. After they do that, they will contact insurance, and the patient, to let them know what’s due. The insurance company will then pay their portion, and send what’s still due to the patient.
The final step! This step is where either the customer or the insurance pays off the amount. It’s marked off as paid, and their owed account gets closed for the time being.
The only complication here is if the patient is uninsured, and refuses to pay, the biller may be stuck having to contact the patient continually. Forty-one percent of Americans have some form of medical debt, so, unfortunately, it’s not uncommon for patients to refuse to pay.
If the patient doesn’t pay and is uninsured, unfortunately, there is one more step. This step is for the billers to pass on the owed amount to a medical collections agency. A collections agency is the very last option since they buy the debt off of medical firms for pennies on the dollar. The collections agency will then go on to make the moves they deem fit to collect payment.