How to Bill for Your Medical Practice

Physicians use trained billing and coding experts to maximize reimbursement from insurance companies and collect on patient accounts. The entire billing cycle turns a patient visit into a medical claim, generating revenue for the medical practice to continue seeing patients.

Instructions

• 1

  Verify correct contact and billing information for your patient. Ask for a current mailing address, contact numbers and health insurance information.

• 2

  Explain your financial and privacy policies to the patients and have them sign a financial responsibility document. Not all services are covered by insurance. A signed copy stating the patient accepts financial responsibility is required if an account goes to collections.

• 3

  Document the patients' chief complaint, or reason for visit, and keep detailed notes in their medical charts. Insurance companies may require copies of medical records before they pay a claim.

• 4

  Code the claim. Medical claims tell an insurance company why a patient was seen (ICD-9 or diagnosis) and what services the physician provided (CPT or procedure code). Assigning the correct combination affects how the claim will process and pay.

• 5

  Enter charges into your billing software. Charge entry creates electronic claims.

• 6

  Scrub your claim for errors. Most billing software is programmed to warn you if information, such as modifiers or system edits, is missing or needed.

• 7

  Transmit your claim directly to the insurance company or upload your claims to the clearinghouse. Your clearinghouse is where electronic claims are received and submitted.

• 8

  Call the insurance company to follow up on claim status. Normal processing time is approximately 30 days from the date the claim was sent.

• 9

  Post payments from the insurance company to patient accounts.

• 10

  Bill the patient after you receive an Explanation of Payment (EOP) from the insurance company. This shows how the claim processed and will show if there is a patient balance.