Uderstanding the Patient Intake Process

Steps in the Medical Billing Process

Deborah Carmichael


July 11, 2010
Allen Chighizola, MBA, S.S.P.

Steps in the Medical Billing Process

    There are several steps in the medically billing process. These steps should be followed to ensure appropriate, timely payment for patient’s medical services. Further, these 10 steps help provide more billing accuracy for medical service providers.
    The first step is to pre-register the patient. This procedure involves collecting current information, such as, address, phone number, and updated insurance information. After this is done appointments are scheduled.
    In the next step it is the medical insurance specialist responsibility to determine the financial responsibility the patient’s visit. When the patient has insurance there are questions that must be asked.
    • What services are covered under the plan? Why does the patient need this service?
    • Are these services covered?
    • What billing rules refer to the plan?
    • What is the patient’s responsibility for payment?
These questions are necessary to ensure proper billing of the patient’s covered services. This also helps the medical insurance specialists on what to bill the patient when benefits do not apply.
To determine financial responsibility these procedures are followed:
    • Verify patient’s responsibility for their health plan
    • Check the health plans coverage
    • Check if patient has more than one health plan. If so then the first health will be billed.
    • Follow payer’s instruction for payment such as, preauthorization.
  The third step is to check in-patients when they arrive for their appointment. If the patient is new, demographics for the patient must be collected at the front desk. Returning patients should be asked to review demographics and medical data to make sure it is up to date. Financial records should be checked to make sure no balances are due. Insurance cards, and photo Id’s should...