UEI Business Office Administration

Medical Billing Capstone projectby Jeffry Sandoval

Task 1: Present medical billing and collections process

Task 2: Step-by-Step flowchart:

-register new patient

-create new case for existing patient

-create and CMS 1500

Task 3: Short speech about medical billing and collection in the 21st

Century

Frank Ezenekwe Mod 160

Medical Billing ProcessPHASE 1

1. Patient appointment and preregistration

2. Insurance information(obtained and verified)

3. HIPAA Notice of Privacy

4.Insurance identification card photocopied

5. Patient’s signature requirements

6. Assignment of benefits

7. Patient’s financial account

PHASE 2

8. Medical service performed

9. Patient’s financial data posted and patient check out

PHASE 3

10. Insurance claim electronic creation

11-12. claim transmission

13. Provider’s signature

14. Track pending insurance claims via practice management software

PHASE 4

15. Payer processing-payment received with explanation of benefits document and electronically posted

16. Bank deposit and unpaid claims followed up

17. Balance due statement mailed to patient

18. Full payment received and financial records retained

-patient walks in for

appointment

-patient’s info is updated

CheckInsurance incase of changes

(insurance, plans)

Patient receives NPP

(Notice of Privacy Practice)

HIPAA

Make photocopies of Insurance identification card front &

back

Signature not required for TPO

under HIPAA

Authorization for Release of

Information form accessible ready

Patient must sign an Assignment of benefits

in order to receive reimbursement directly

from the insurance payer

Patient info is entered into the

practice management

software program.

PHASE 1

Patient Registration

Verification of Insurance

Notice of Privacy practice

I.D. RecordsPatient’s Signature

Requirements

Assignment of Benefits

Patient’s Financial account

PHASE 2

Treat Patient

Form (charge slip) is attached to

Patient’s record on visit with

Physician’s signature

A/R management establishes

patient’s financial account records

and carry out claim process

Patient checkout and leave medical

office

Services Encounter Form

CheckoutFinancial Record

Billing specialist makes electronic

insurance claim as required by HIPAA

Paper copy of CMS-1500 form is placed in the office’s pending file or

patient’s health records chart.

Electronic claims are sent to a clearing house for data correction.

Medicare program require

an original signature of the

provider.

The Practice management

systems dates all claims generated and keeps track of aging reports along with

the A/R amount due

PHASE 3

Claim Transmission

Insurance Claim

Provider’s Signature

Pending Insurance Claims

Remittance statement is generated and sent.

Payment is accompanied by explanation of

benefits. Payment posted to Financial Record.

Check and corresponding EOB/RA

sent to health care provider. Electronic funds transfer (EFT)

may be used instead of paper check.

Monthly statement for any outstanding balance

should be sent indicating that

insurance has been billed and the amount

due is the patient’s responsibility

Health care provider retains records and

copies all forms used in patient’s case along with

logs of all telephone conversations and

actions taken regarding insurance disputes or

collection activities

PHASE4Payer Processing

Bank deposit & unpaid claims follow up

Balance due statement mailed to patient

Full payment received and financial records retained

Register new patient

1. Open Medisoft2. Click on “list” tab3. Open “Patients/Guarantors and Cases list”4. Click on “New Patient”5. Input patient’s general information and other

information, then click save.

Creating a new case for existing patient.

1. Open patient list2. Click on case radio button on the right top corner3. Click “new case”4. Enter Patient information (policy, diagnosis, personal, etc.)5. Save and exit

CMS 1500

Name: Jane DoeDOB: 07/04/1976Patient’s Address: 123 Washington ave. Springfield IL, 60640Patient relationship to insured: SelfPatient status: SingleDate of Illness: 07/04/10Provider’s name: Big Insurance Co.Diagnosis: Back PainDate of service: 07/04/10