Introduction to the Medical Billing Cycle Chapter One lecture 3 OT 232

1. 1 Introduction to the Medical Billing Cycle Chapter One lecture 3 OT 232

2. 1-21 1.8 The Medical Billing Cycle • A medical insurance specialist is a staff member who handles billing, checks insurance, and processes payments • To complete their duties, medical insurance specialists follow a 10-step medical billing cycle • This cycle is a series of steps that leads to maximum, appropriate, timely payment

3. 1-22 1.8 The Medical Billing Cycle (Continued) • Step 1 – Preregister patients • Step 2 – Establish financial responsibility for visits • Who is primary payer? • Step 3 – Check in patients • Step 4 – Check out patients • A medical coder is a staff member with specialized training who handles diagnostic and procedural coding • The patient’s primary illness is assigned a diagnosis code

4. 1-23 1.8 The Medical Billing Cycle (Continued) • Step 4 – Check out patients (continued) • Each procedure the physician performs is assigned a procedure code • Transactions are entered in a patient ledger—a record of a patient’s financial transactions • Step 5 – Review coding compliance • Compliance means actions that satisfy official requirements • Step 6 – Check billing compliance • Step 7 – Prepare and transmit claims

5. 1-24 1.8 The Medical Billing Cycle (Continued) • Step 8 – Monitor payer adjudication • Accounts receivable (A/R) is the monies owed to a medical practice • Adjudication is the process of examining claims and determining benefits • Step 9 – Generate patient statements • Step 10 – Follow up patient payments and handle collections • A practice management program (PMP) is business software that organizes and stores a medical practice’s financial information

6. 1-25 1.9 Working Successfully • Professionalism isacting for the good of the public and the medical practice • Medical ethics are standards of behavior requiring truthfulness, honesty, and integrity • Thinking it Through, page 29 • Etiquette is comprised of the standards of professional behavior

7. 1-26 1.10 Moving Ahead • Certification is therecognition of a superior level of skill by an official organization • Provides evidence to prospective employers that the applicant has demonstrated a superior level of skill on a national test