1. Summary of ten steps of the billing processes and procedures. (explain each process)
In addition include:
a. Content and use of Registration or Encounter Forms,
b. Explanation of Benefits (EOB), and Remittance Advice (RA),
c. Advance Beneficiary Notice (ABN),
d. Participation Contracts,
e. The adjudication process for payers and providers.
A. Pre-registering patients: The main function of the first step is to schedule and update appointments as well as gather personal and insurance information about new and existing patients. New patients provide personal and insurance information to the scheduler, and pre-existing patients update any personal or insurance information with the practice that has changed.
B. Establishing financial responsibility: The second step is viewed as the most important because it determines what services will and will not be covered by medical insurance. It also determines if the patient or the insurance company is responsible for the payment of services. In a lot of cases, payment plans will be offered to patients with high out-of-pocket self-pays, like specialized procedures that insurance will not cover. Even if medical insurance is used, a copayment is generally required by the patient. Many physicians participate in more than one insurance contract, which are judged by the financial arrangements that are offered by the plan. Managed care systems are the most popular with physicians.
C. Check in patients: In this step, new and returning patient information is verified, outstanding balances are reviewed, insurance information is taken and placed in the patient’s file, necessary paperwork such as privacy and release of information statements are signed by the patient, and out-of-pocket expenses such as copayments and self-pay fees are collected from the patient. One form that may be presented to the patient by the physician is an advance beneficiary notice of noncoverage (ABN). An ABN will be presented to a patient to sign if the provider believes the procedure or treatment will not be covered by Medicare because it is not reasonable or necessary. The patient will be advised of this before the procedure or treatment begins, giving them the option of whether or not to follow through with the encounter.
D. Check out patients: In this step, diagnoses and procedures are recorded and assigned a medical code, which is recorded on an encounter form by the physician or the billing specialist. An encounter form is used to record the services provided by the practice. Encounter forms are also known as charge slips, routing slips, and superbills. Encounter forms list the practice’s most performed procedures and corresponding codes (fee schedules) for easy filing, as well as any insurance companies under contract with the practice. Previous balances, coinsurance, deductibles and fees for uncovered services are also listed on the encounter form and brought to the patient’s attention. Upon payment of the patient’s balance,...