Question

You just stepped into a new role as an office manager. Due to a lack of consistency throughout the office, you have been asked to update the billing policies and procedures to include the following elements: Step-by-step instructions for the entire revenue cycle from pre-verification of insurance to accounts receivable management. Methodology your office will use to determine a pricing structure. Considerations for negotiating insurance contracts. Considerations for private pay and charity care.

Answer 1

Scheduling

Collect correct information about the patient and exchange information regarding financial policies and payment options and what the program covergae would be.

Eligibility

Connect with the insurance provider to assess eligibility of the patient.

Reminder Call

Inform the patient 2 days in advance about their appointment and insurance eligibility.

Registration

• Cross check with the patient about information provided earlier.
• Make a copy of the insurance card of the patient.
• Establish the income of the patient and get necessary forms signed.

Eligibility

Verifiing the insurance documents submitted to the hospital with the insurance provider and check eligibility of the patient. Also collect information regarding the actual amount the patient may end up paying.

Visit

• The insurance company uses the coding used during billing of the patients vists.
• Suport all charges and codings with proper documents.

Checkout

• Print bill of the patient and discuss the charges and what medical issu is covered and to what amount.
• Enter the amount paid by the patient after receiving the payment.

Claims Submission

• Review codes
• Check if the codes and charges are posted correctly

Payment Posting

The hospital staff will display the payments or any denials.

Claims Follwup

Follow up any claims / Bills that are unpaid

Patient Billing

• Send the balance bills to the patients
• Send them details regarding insurance claims and any denials
• Furnish payment options available to the patients.