Padgett
HCR/220
Instructor Tosha Jessica Ellis
University of Phoenix
Due: December 18, 2011
STEP 1:
Preregister PatientsThere are two steps involved in this step, which are to schedule and update
appointments and collect preregistration demographic and insurance information.
During this step, the scheduler answers the phone and takes the callers, or patients,
basic information. This includes their personal and insurance information. They
also ask the patient what the reason for this appointment is so that they can
schedule it accordingly.
STEP 2:
Establish Financial Responsibility For the VisitThe se4cond step is very important because this is where the physician, or whoever
else it may be, find out who will be responsible for the financial obligations. If the
patient is insured, the staff member must find out the answers to a few questions.
For example, they need to know what, exactly, is covered, what is not covered,
billing rules of the plan, and what the patient is responsible for paying out of
pocket.
STEP 3:
Check In PatientsThis step involves checking people in as patients. When the patient comes in for
their first visit, the front desk staff collects detailed and complete demographic and
medical information for the patients medical record. They also make copies of the
fronts and backs of the patients insurance cards and identification cards. The
patient must pay their copayments as well, if any is due.
STEP 4:
Check Out PatientsDuring this step, the medical codes for the visit are recorded. When the physicians
office bills the insurance, the diagnosis and procedures must be in codes. These
codes are listed in a medical reference book called, International Classification of
Diseases, Ninth Revision, or ICD-9-CM.
STEP 5:
Review Coding ComplianceThis step involves checking all the codes that have been recorded for errors. This is
done to make sure that the diagnosis and services that have been coded easy are for
the payer to understand as well as to make sure each code, or service, was a
necessity.
STEP 6:
Check Billing ComplianceWhen a service or procedure is rendered, there is a procedure code listed on each
practices fee schedule. Sometimes, a code may not be billable. This is where this
step comes in. The staff must go through and make sure that each one can be billed
on health care claims.
STEP 7:
Prepare and Transmit ClaimsThis step involves preparing and transmitting each claim to the insurance. A lot of
practices transmit their claims electronically. Each claim states information
referring to the diagnosis, procedures, and charges.
STEP 8:
Monitor Payer AdjudicationThis step is where the practices collect any bills that are due to be paid.
Adjudication is the process where the payer decides what to do about each claim.
For example, they can decide to pay it fully, pay a partial payment, or deny the
claim. A medical insurance specialist compares every payment with every claim to
make sure there are no discrepancies. If there are, there is an appeals process that
can be used.
STEP 9:
Genetic Patient StatementsDuring this step the payers payments are put into the right patients account.
Usually the payments do not pay the whole bill. If this occurs, then the patient is
billed for what is left. The bill lists the date of services and the services that were
rendered as well as any payments that were made by the patient or payer and the
balance due.
STEP 10:
Follow Up Patient Payments and handle collectionsThis step involves checking for overdue bills. Each practice has a financial policy
that states how long a patient has to pay their payments. If the patient has not paid
their overdue payments by the set time a collection process is started. After this,
the patients record and financial records are filed according to a federal and state
regulations, which state what to keep and for how long.