Mecial Biling Process

In: Business and Management

Submitted By ccrittle
Words 475
Pages 2
Corrie Crittle


Medical Building Process

Documentation at the Front Desk:
The patient hand over an insurance card, this case the patient has Humana. On the care the office manager needs to verify if a referral or pre-authorization needs to be obtained and then contact the respective Primary care physician and get his documentation. Insurance verification data and a copy of the insurance card is sent to the billing office. The billing office scans the information and saves the documents. The Scanning department retrieve the information and it sent to the appropriate departments. Pre-coders then enter the key-in codes for insurance companies, doctors and modifiers. Pre-coders also add insurance companies, referring doctors, modifiers, diagnosis codes and procedure codes. The coding team assigns the Numerical codes for current procedural terminology and the diagnosis code based on the description given by the provider. The charge team has competent individuals who would first enter the patient personal information form the information given. Also they check for the relationship of the diagnosis code and the current procedural terminology. They create a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within an agreed turnaround time, about 24 hours. The daily charge entry then needs to be audited to double check the accuracy. Claims are filed and information sent to the transmission department. This department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted, confirmation report are obtained and filed after verification. The carrier adjudication department would review the claim and after their edit checks, the claim would be adjudicated on and processed for payment. Cash application team receives the cash files…...

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