So, what’s really involved in the billing process? That’s a question we are asked quite a bit when we meet with potential clients. On the surface it sure seems straight forward and easy. We send out claims and the money comes in the door, but what’s really involved in the entire billing process is not such an easy answer.
Billing Effectively Is a Complex Process
There’s an awful lot of steps. Picture walking up a stairwell going from the ground floor to the top floor. Every floor is a milestone in the billing process, and they all have several steps to get from one to another. To accomplish this, we need to have a system in place for the organization to follow.
We must also ensure that all the steps are carried out the same way every time and that our processes are correct and sound. The billing process starts when the patient picks up the phone and makes an appointment. At that point your organization needs to collect enough information so you can take the next step, which is to call the insurance company.
It’s Important to Establish That a Patient Actually Has Insurance
We need to establish that the patient is actually covered by the insurance carrier before that first treatment. If the patient does not have qualified coverage, we really should call them back before that first visit and let them know that they aren’t covered. This often leads to a cancellation. Now we’re not wasting a productive spot on the schedule by assuming that they have insurance that will actually pay a claim.
When a patient arrives for their first visit, we need to obtain copies of their driver’s license and both sides of their insurance card. That way we know that we have all the information we need to register them into the billing and records system.
Once the Provider Completes Treatment, the Billing Takes Place
After treatment, the actual billing takes place by the provider. The provider gives the patient charges to the charts personnel who inputs the data into the billing system. Sometimes they automatically come across from the EMR. We still need to ensure that they are reviewed, and any needed modifiers are applied.
The goal is to make all claims as clean as possible before they go out the door to the insurance company or clearing house. It doesn’t matter if you submit electronically or use the red 1500 form, you need your claim to be 100% complete and clean.
Then we wait. And wait, and sometimes wait some more for the insurance carrier to pay. This can typically take two to three weeks for the check to be in the mail or an electronic draft issued directly to your account.
The billing process continues with ensuring that the funds are applied to the correct patient account. Then there’s a follow up process to issue any needed statements for incomplete accounts. We then need to have a system to send our subsequent statements every 30 days until the account is satisfied.
The Process Continues Long After the Carrier Pays a Claim
Once all the money is in house, we then need to audit the account to make sure that everything happened correctly and on time. Now the account can be closed. If something falls through the cracks, or we have some denials, then we need to address those as well. Whether that means we appeal or make corrections and resubmit the claim. We want to get these issues resolved as quickly as possible.
On the surface the billing process seems simple, but most practices have at least 8 steps in the process of moving from A to B. With A being the patient calling for an appointment and B being the money hitting their bank account. It’s not a painless process and it’s not just one person making it happen. It involves everyone from the front desk to the billing department.
Hopefully this sheds some light on the process and gives you a place to start asking questions about your own billing systems and practices. If you have further questions, including how we can remove this entire cumbersome process and let you and your team focus on making patients better, let us know.
We’re always here for you.