The Process of Medical Billing

It used to be a widely used idea that we were all going to be nothing but numbers. In certain cases, that’s not the reality, but when it comes to medical billing and coding those numbers, codes and other identifying information better make sense or the insurer won’t be paying the medical bill. Medical billing is a sequence that begins with a call to make an appointment to see a doctor or other medical professional. There’s a sequence of questions asked, among them the patient’s name, date of birth, and insurance information is confirmed or updated. With all of that information updated and in hand the team at the clinic or medical office can verify the insurance coverage and confirm benefits.

While with a doctor, notes are taken that detail the appointment. Everything is jotted down from treatments to diagnoses, prescriptions, and services provided. Once the medical encounter is concluded the notes that were taken are turned over to a medical coder. This person transcribes those notes into a medical code. That’s the fancy way it is submitted to an insurer for medical billing purposes after the price for the claim is added. The price is listed next to the code that it applies to. Prior to filing the claim, it should be reviewed and ensured to be clean. This is a process known as “scrubbing”. It ensures that payment is more rapid because all mistakes are caught before submission to the payer. Then the waiting for payment begins, during adjudication the payer decides how much of the claim will be reimbursed. Sometimes even with a clean claim, you could receive a denial. Then your claim needs to be received, the payer’s decision needs to be looked at. Then the appeals process begins. If you don’t need to resubmit: Congratulations that means that your claim was approved, and you should be getting ready to receive payment. The process from submission to reimbursement could be a long one, which means keeping track of all your accounts receivable and understanding which reimbursements you’ve received and which will need to be altered and resubmitted. In order to not get caught up in this cycle and receive reimbursement for your claims seeking the help of Gables Medical Billing’s team of medical billers is the best option. We pride ourselves in handling all claims submissions, follow-ups, appeals, and payment postings with the deepest dedication and the best customer service in the industry.