In the case of an old patient, one already in the practitioner’s care, their record is updated with new pertinent detail added to their folder. This is a critical step because thanks to that data the medical billing process can begin. If the patient is delinquent in their payment, or if they do not pay the full amount, it is the responsibility of the biller to ensure that the provider is properly reimbursed for their services. This may involve contacting the patient directly, sending follow-up bills, or, in worst-case scenarios, enlisting a collection agency.

This can be a long and arduous process, which is why it’s imperative that billers create accurate, “clean” claims on the first go. Once the medical billing professional confirms the accuracy of the claims, they become ready to submit. Mostly, medical claims are submitted electronically and insurance companies have a different schedule for claim submission. At this stage, it’s necessary that all the requirements of the payer are met, and the claims are then processed.

Patient Registration

Each of these procedures is paired with a diagnosis code (an ICD code) that demonstrates the medical necessity. Claims also have information about the provider, listed via a National Provider Index (NPI) number. Some claims will also include a Place of Service code, which details what type of facility the medical services were performed in. The medical biller takes the medical billing process superbill from the medical coder and puts it either into a paper claim form, or into the proper practice management or billing software. Biller’s will also include the cost of the procedures in the claim. They won’t send the full cost to the payer, but rather the amount they expect the payer to pay, as laid out in the payer’s contract with the patient and the provider.

Sometimes you may find procedure codes that are out of order in the code manual. Placing codes out of numerical order allows for clustering of similar procedures, and can help the medical coder find exactly the right procedure code. These out-of-sequence codes typically have a note instructing the coder to flip to the correct code elsewhere in the book. These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes.

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They assist in reducing claim backlogs and boosting patient engagement. Implementing digital solutions can help you produce accurate invoices. Billing platforms enable patients to schedule appointments, access critical documents and fill intake forms via the patient portal. Communication modules allow you to follow up with customers to drive positive care outcomes.

• Each claim includes information on the patient, including their demographics and medical history, as well as the procedures carried out (in CPT or HCPCS codes).
• It can take months and several communications before you reach the collection stage.
• There are codes in Category I for unlisted procedures, but if the procedure, technology, or service is listed in Category III, you are required to use the Category III code.
• (If the patient has secondary insurance, the biller takes the amount left over after the primary insurance returns the approved claim and sends it to the patient’s secondary insurance).
• Claims additionally have details about the provider, listed via a National Provider Index (NPI) number.
• This is an awful lot of information to take in regarding Category I CPT codes, so let’s review briefly.