Question

The claim submission process is very complex. Give an overview of the process and explain the importance of each step. Please provide detailed explanation.

Answer 1

The claim submission process is the medical billing insurance claims process which starts when a healthcare provider treats a patient and then sends a bill of services provided to the designated payer, which is usually the health insurance company.

the six key steps of a successful medical billing process are:

Patient Check-in

The first stage of a patient's appointment should include the notation of patient's demographic information as well as the information about his/her insurance, such as insurance payer and the policy number.

Insurance Eligibility and the Verification

Even the regular patients also need to verify their insurance information and the eligibility before every appointment because Insurance information can change at the any time, which is why you need to ask the patients before every visit when if their insurance information has changed. A change in the insurance information can also impact benefit and also the authorization information.

Medical Coding of Diagnosis, Procedures and the Modifiers

The correct coding of the claims is vital for the informing insurance payer of what exactly the patient is being treated for as well as method of treatment the patient is undergoing. Be sure that to use the correct diagnosis codes which describe the patient's symptoms or the illnesses and the correct procedure codes to describe patient's method of treatment. Use the accurate CPT and HCPCS code modifiers to provide the additional information.

Charge Entry

It refers to entering the charges for the services in which the patient received. The charge entry is also includes the appropriate linking of the medical codes to services and the procedures rendered during the patient visit.

Claims Submission

When the claim has been completed, then it submitted to the insurance payer for the payment. Medical billers need to have access to information they need about insurance payer since there are many variables for each of the insurance payer in determining how and when to submit the claim.

Payment Post

In this ,it involves posting and the deposit functions, in this the amount billed to the patient will be zero if it has been paid in full or it will reflect amount owed by the patient. The insurance payer's responsibility should have been met by payment post step in process.