The first step in the Medical Billing Process

Heilpraktiker München - Grünwald Heilpraktiker Grünwald

There are ten steps in the Medical Billing Process.
The first step in the process is to Pre-register the New Patient. There is much critical information that must be obtained at this juncture: (Demographics) patient name, address, phone number, date of birth, the nature of the medical problem, the insured’s name address, phone number, date of birth, relation of insured to the patient, the type of insurance does the patient has, insured’s ID number, are referrals needed, is Prior Authorization needed, referral or authorization phone numbers if provided on the card, copay amount, co-insurance.

It also helps to know if the nature of the medical problem is due to an auto accident, slip and fall accident or work related accident. This information will dictate if commercial insurance is primary or if other insurance is primary. The information obtained at the “pre-register” step is crucial to the billing process and receipt of payment.

The more information you ask for at this step in the process, the easier the remaining nine steps will be! I must emphasize that this information is critical to the entire billing process/revenue cycle. This information will help you to adjudicate claims as quickly as possible.

In addition to obtaining this information, your staff must double check that the information is correct and complete. Incorrect spelling of first or last name or incomplete insurance ID number sounds like trivial mistakes, but in my eighteen years of billing, collections and supervision in DME (Durable Medical Equipment), Skilled Nursing, Home Care, Orthopedics, Mental Health and Radiology, I have encountered denied claims due to inaccuracy of these very items! In some of my cleanup of aged accounts, I have encountered many claims denied for No Referral or No Authorization totaling tens of thousands of dollars.
The protocols that you set up at the front end to obtain the pre-registration information will help minimize your denials and increase your cash flow.

Remember, the “cleaner” a claim is going out the door; the more likely it will be paid on the first submission! Some practical tools to use to obtain this information: have a “new patient” checklist so that this crucial information is obtained, have an “existing patient” check list to make sure you capture any changes in patient or insurance information, have a Participating provider/insurance grid, remind the patient to have their insurance ID card with them at time of visit.

About the Author
Samuel D. Deutscher attained a BS in Business Administration from the University of Bridgeport. Samuel has worked in healthcare billing, collections and revenue cycle management for over eighteen years.


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