Workflow process in Medical Billing

The following details provides the workflow of Medical billing process.

1.  The doctor sees the patient. After seen the patient, Dr front office person send the all information pertaining to the patient which includes Patient Demographics (Face sheet), super bills/charge sheets, insurance verification data and a copy of the insurance card to Indian Billing office via FTP/fax .

2.   In Billing office, Scanning department retrieves the files and prints them and ties up with the control log for number of files and pages. 

4.   Illegible /missing documents are identified and a mail is sent to the Billing office for rescanning.

6.     Coding and pre-coding of the super bill/charge sheet and demographics for insurance, doctors, modifiers, CPT and diagnosis are done wherever required.

7.       The claims data entry operator creates a charge, according to the billing rules pertaining to the specific carriers and locations .All charges are accomplished within the agreed turnaround time with the client.

8.       Charges are verified by audit department for accuracy and compliance with rules.

9.       Claims are filed and information sent to the Transmission department.

10.     Transmission department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted electronically, confirmation reports are obtained from clearing house and filed after verification. Paper claims are printed and attachments done if required and put into envelopes and sent to the US for postage and mailing.

11.    Clearing house transmission rejections/errors are analyzed and take corrective action and again transmit the claims to clearing house

12.    Once recieve the EOB( Expalnation of Benefits-Payments),  Cash applied team receives the cash files and post the payment in the respective accounts. This would helps to reconcile the deposits at the end of each month. while psoting the EOBS, Overpayments are immediately identified and sene the information to Dr office to refund the amount into the respective insurances. 

13.     All rejected/denied claims,  research the reason for denial with remark codes in the EOB’s or Explanation of Benefits received and take appropriate action to resolving the issue. 

14.     AR analysts are the key to any group. They record the processing time of each insurance companies and identify all claims falling above the processing time. Then the claims are researched for completeness and accuracy and insurance carriers are called if required. AR analysts are responsible for the cash collection and resolving all problems to enable the account to have clean AR. 

15.     Insurance Calling team, calls to the insurance companies to identify the  reasons for non-payment of the claims.Calling details are passed on to the AR Analysts for resolution. Calling team works during the American Time zones.

16.    Patient calling team calls up the patients to confirm receipt of bill and when they are going to pay. Based on client’s approvals budget plans and discounts for immediate payments are also undertaken.