How to prepare a medical billing claim
Anyone in the healthcare industry will tell you: the medical billing process is long and complex. Luckily, there’s advanced billing software options on the market that makes the whole process much more manageable. Still, understanding each step and what those steps entail is the best way to take control of your billing operation. Knowing the details and logic behind each step and what to do to prevent errors down the road will make your relationship with billing a much more pleasant experience overall. Don’t just take our word for it—use the following steps the next time you have to prepare a medical claim, and see the difference precision and accuracy makes.
Patient registration and questionnaire
Name, date of birth, address, medical history, current reason for the visit, and more. These are just some of the many pieces of information providers need to document during the registration process. If you’re dealing with a new patient, you’ll want to gather as much information as possible to create the file. Current patients should also be questioned carefully, making sure all information is up to date. It’s easy to want to rush through this part, but it’s often where the most mistakes come from. Take the registration process seriously to set yourself up for a successful claim.
Verify insurance coverage
This step is arguably the most important: don’t forget to verify a patient’s insurance coverage. If you’re dealing with a new patient, collect their current provider information and policy number. If you’re working with a returning patient, it’s just as important to make sure all information is up to date, including both the provider and the coverage of requested services. If incorrect insurance information is documented, it can cause rejected or denied claims down the road.
Create the superbill
The superbill is essentially just a form that contains all necessary information for the claim, including personal patient data, insurance information, services performed at the appointment, along with the diagnosis and billing codes.
Create the medical claim
The moment is finally here. It’s time to create the medical claim. At this point, you have all the information required to create your medical claim, but this part of the process shouldn’t be rushed. Even though you’ve been careful up until this point, this isn’t the time to get reckless. Make sure all coding and billing codes are correct—it’s best to do this with medical billing and billing NEMT software, which automatically scans for errors in every claim.
Submit the claim
If you’re using medical billing software, submitting a claim is simple with the click of a button. Your system scans for errors and, after verifying there aren’t any, sends the claim off to the insurance provider for review. Another great part of billing electronically is that you’ll receive your reimbursements much quicker than you would manually, so while time frames differ based on a variety of reasons, you shouldn’t be waiting around too long before you hear back.
Track the claim’s status
If you submitted your claim electronically, you can monitor its status through the software. Once payers have had time to review it, you’ll receive word back. A few different outcomes are possible here, the most ideal being that you’re paid correctly for the claim. If a piece of information wasn’t correct, you could end up with a rejected, denied, or incorrectly paid claim. From there, you’ll have to make the necessary changes and wait a little longer for your payment.
Write the patient statement
This step depends on whether any outstanding balance remains. If money is still owed, it’s time to bill the patient what they owe. On this statement you should include the total cost, what services insurance covered and how much they paid, and the remaining balance.
Follow up with the patient if necessary
If the patient hasn’t paid their outstanding balance by the due date, send a follow up call or email.
Take your billing to the next level with software
Medical billing isn’t easy, but with the right software, it can be very manageable. Get in touch with the iSi team to find out what software is right for your business. Whether you’re an NEMT provider, Medicaid biller, or working in another part of the healthcare sector, we have a product for you.