Medical Billing: The Process

Medical claims go through a process like any other claim would, but medical claims processing is convoluted and hard to explain to the untrained person. This is why it’s so crucial to do your Medical Billing with Gables Medical Billing. Our medical billers are trained to handle all claims submissions, follow-ups, appeals, and payment posting with the ardent dedication your practice deserves and you’ll come to expect from us. The billing process, in essence, is:

• The patient comes into your practice and hands over their insurance card, and updates or fills out their demographic information, which kicks off the medical billing process.
  • Within this information is their date of birth, name, address, Social Security number, driver’s license number, and name of the policyholder, if not the patient.
  • You will then verify the patient’s coverage and information as it pertains to the procedure(s) being performed.
• Then comes the fun part, the patient’s visit with the practitioner. After this point, the practitioner will document the procedures and submit this to the coder.
• The coder will abstract the billable code, based on the documentation submitted by the provider.
• The coding would then go to the biller, which enters the information on the claim portal or software submitting it to the insurance provider, or payer.
• At this point, the payer goes through adjudication and comes to a decision of paying, and accepting the claim or denying If the claim is denied, you will need to clean and resubmit the claim.

If you’re working with the Gables Medical Billing team, we will follow your claim all the way through the process and ensure your payment is posted in a timely manner.