Billing information

Billing for the patient begins when they schedule an appointment. To begin the collection of billing information, information regarding patient registration and schedule is used. Accurate clinical information collected during the patient encounter is also crucial for medical billing. Information cannot legally be used for billing if it is not properly documented during the encounter. Health care providers will be committing fraud if they charge the payer for services that are not documented. Additionally, in case of conflicts, the clinical documentation must be used to justify the reimbursement to a patient or a payer.

When a patient gets checked in, staff from financial services ensures to collect patient information. This information covers the home address of the patient and their current insurance coverage. These staffs are also responsible for verifying the patient’s financial responsibility.

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Medical billers and financial staff must also verify continuously if the services offered to the patient are covered by their insurance or not. The authorization for the same must be submitted as the services take place. When a patient is about to check out, the medical billers use patient information to prepare the superbill. Superbill is used by health care providers to create insurance claims. The superbill contains provider’s name, provider’s location, provider’s signature, the national provider identifier, list of attending physicians, patient’s name, patient’s date of birth, patient’s insurance information, the first symptom of patient, date of services, time, and authorized information. In some cases, the provider adds comments and notes to the superbill to justify certain medical care. Once the patient checks out from the hospital/clinic, the healthcare provider generally submits the superbill for claims on behalf of the patient. Once the insurance company processes the claim and pays for the portion of the bill, the remaining must be paid by the patient or the payer. Certain health care plans have a network of hospitals and doctors that will only get insurance coverage. In case the patient gets medical care out-of-network, the patient will be responsible for the payment as the bill is not covered by insurance.

Billing is extremely important as it affects the revenue cycle of the health care industry. Billing information also impacts the reimbursement to the payer for the health care services obtained. Therefore, it is necessary for the service providers to fully understand the fundamentals of billing to have a smoother revenue cycle while providing proper reimbursement to patients.

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