subject: Medical Billing- The Back Office Function [print this page] Proper management of the medical billing and coding staff is critical to a successful practice. Even minor problems in this area can negatively impact the cash flow, financial stability, and morale of the practice.
Prior to the Appointment
It starts prior to the patient opening the door of the office for his/her appointment. It actually begins the moment the patient contacts the office for a visit. They have to be scheduled, their benefits need to be verified and all necessary documentation has to be prepared and assembled. If the patient needs to bring in x-rays or test results, he needs to be reminded of that along with being reminded of the appointment itself.
The Appointment
On the day of the appointment, the patient must complete and/or update their patient information sheet. The office staff will need to get a copy of the patient's healthcare provider card and id. The assignment of benefits and HIPAA forms must be signed.
Prior to the patient leaving the office, the staff may collect want collect a payment. If deferred billing arrangements have been made, them this may be a good time to review those.
If the patient is a no show, that has to be notated immediately on the patient's chart and the primary doctor must be notified.
After the Appointment
After the visit, all the procedure, findings and treatments listed on the patient's chart must be immediately documented onto what's known as a super bill, charge sheet or slip, or an encounter form. Every procedure and diagnosis has to be matched and coded correctly.
The visit itself has to be documented by the physician. Otherwise there could be potential liability issues if another medical staff member enters an incorrect procedure or diagnosis.
The medical coding staff will then review the patient's chart against the super bill. This is to make absolutely sure that the diagnosis codes match the procedures and treatments. Detailed explanations are sometimes required for certain procedures. The coder must have accurate documentation without omissions and as error free as possible. When the information is entered into the database for medical insurance billing, any problems will delay reimbursement.
Billing
If the patient has insurance, the bill goes to the insurance company first. After they've reviewed the EOB (Explanation of Benefits) form, the patient will be billed for any remainder.
All this is done so that a clean claim can be submitted in a timely manner. It's best to have all of the information as complete as possible from the start, going back to prior to the patient even coming into the office.
Otherwise payment for medical services will be delayed because of rejected claims. In fact, the claim rejection rate for a practice doing all or some of the medical billing on their own can be as high as 33%. Good medical billing firm's rates are below 5% and the elite companies are at around 2%.
