Medical billing can be a very important process in the health sector. For medical professionals and revenue cycle/reimbursement specialists, having a grasp on the medical billing cycle and the different types of billing is of utmost importance. This post will further explore the medical billing cycle details and medical billing types.
The Medical Billing Cycle
The medical billing cycle is a multi-step process that helps get providers paid for their services. The cycle can be divided into several phases:
1. Patient Registration:
- While there may be various ways to gather information on each patient, the most common way is to have each patient fill in some basic information about them: which includes their personal details, their insurance details, and their medical history.
- Ensuring insurance coverage and eligibility
2. Insurance Verification:
- Verifying the patient’s insurance benefit for the planned medical services.
- Identifying the patient’s benefits and what (if any) co-payments/deductibles are due.
3. Medical Coding:
- Converting the notes of the healthcare provider and the medical procedures into their standardized codes.
- Using ICD, CPT, and HCPCS codes.
4. Charge Entry:
- Inputting the correct codes and charges into the billing system.
- Documenting that services were rendered correctly.
5. Claim Submission:
- Filing claims with insurers or payers;
- Submitting claims electronically or via paper as necessary
6. Claim Scrubbing:
- Let us look at the steps followed in billing.
- Error detection and correction via software tools to minimize claim denials.
7. Insurance Claim Processing:
- Payers assess and pay claims, ensuring those are accurate and covered.
- Calculating the amount owed to the healthcare provider.
8. Payment Posting:
- Applying payments received from insurance companies to patient accounts.
- Documenting any changes or rejections.
9. Patient Billing:
- Billing patients for any balance remaining after insurance has paid.
- Statements and patient payments.
10. Follow-Up and Collections:
- Tracking unpaid claims or balances due from patients.
- Performing collection efforts when needed.
11. Reporting and Analysis:
- Reporting on billing performance, payment trends, and hold balance.
- Using data analysis to improve the billing process and financial results
Types of Medical Billing
Medical billing cycle can be categorized into various types based on the healthcare services provided and the payment structures involved. Here are the primary types of medical billing:
1. Professional Billing:
Relating to professional services rendered by individual healthcare workers.
Typically found in clinics, physician offices and outpatient settings
Uses a CMS-1500 claim form for submission
2. Institutional Billing:
Encompasses billing for services rendered by health care institutions such as hospitals, nursing homes, and rehabilitation centers.
Comprises room and board, medical supplies and other services provided by institutions.
Submitting on UB-04 claim forms.
3. Ambulatory Surgical Center (ASC) Billing:
BILLING, Provider-based practitioners who perform surgical procedures in outpatient surgery facilities.
Includes some professional and institutional billing components.
4. Durable Medical Equipment (DME) Billing:
- Focuses on billing for medical equipment and supplies, such as wheelchairs, crutches, and oxygen tanks.
- Requires adherence to specific regulations and documentation requirements.
5. Behavioral Health Billing:
Related to therapists, such as psychiatrists, psychologists, and counselors.
This includes unique coding and billing requirements for mental health services.
6. Dental Billing:
- Covers services provided by dentists and dental hygienists.
- Uses CDT (Current Dental Terminology) codes for billing dental procedures.
7. Radiology Billing:
- Involves billing for imaging services, such as X-rays, MRIs, and CT scans.
- Requires accurate coding for both technical and professional components of radiology services.
8. Pathology Billing:
- Concentrates on billing for lab tests and pathology services.
- Includes specific coding for those diagnostic tests and pathology readings.
Conclusion
The medical billing cycle is a complex set of processes integral to the financial health of healthcare providers. By gaining an overview of the medical billing cycle and the different billing types, medical professionals can help guide themselves through the complicated process of reimbursement, compliance with regulations, and revenue cycle optimization. From individual practitioner professional billing to institutional billing for large healthcare facilities, the intricacies of medical billing have to be learned and piece together to thrive in the ever-evolving industry. Synergy HCLS can be instrumental in this transition, providing solutions that streamline and improve the accuracy of medical billing processes.
