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Flow Chart

The document outlines the key steps in a medical billing flow chart, including verifying patient eligibility, coding medical records, generating bills, transmitting claims electronically or via paper, applying payments received via EOBs, analyzing accounts receivable, and taking corrective actions on denied or unpaid claims. Key activities involve entering patient demographics and charges, quality checking the data, transmitting claims, posting payments, tracking metrics on claims and payments, and communicating with providers and insurance companies to resolve issues.

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iEuville
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
346 views

Flow Chart

The document outlines the key steps in a medical billing flow chart, including verifying patient eligibility, coding medical records, generating bills, transmitting claims electronically or via paper, applying payments received via EOBs, analyzing accounts receivable, and taking corrective actions on denied or unpaid claims. Key activities involve entering patient demographics and charges, quality checking the data, transmitting claims, posting payments, tracking metrics on claims and payments, and communicating with providers and insurance companies to resolve issues.

Uploaded by

iEuville
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Medical Billing Flow Chart

Revenue Cycle Management System

Eligibility Patients coverage verified prior to visit

is

Coding Medical Records are reviewed and coded by Certified Coders

Clearing ClearingHouses Houses For For Electronic ElectronicClearance Clearance Hospital Hospital /Docs /Docs office office generates generates Super Superbills bills Demo DemoEntries Entries Charge Chargeentries entries Medical Coding Medical Coding EOBs EOBs Payment PaymentPostings Postings Denials Denials Claims ClaimsSubmission Submission A/R Analysis A/R Analysis Follow Followups ups Insurance InsuranceCalling Calling Patients Statement Patients Statement Patient PatientCalling Calling Customer CustomerCare Care Insurance Insurance Company Company Releasing Releasing payments payments

Demographic & Charge Entry Billing specialists enter patient demographics and charges into the PMS Transmission and Posting Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS

Claims

Accounts Receivable Increase in collection ratio through accurate analysis and timely follow up

Revenue Recovery Old AR are analyzed and corrective measures are taken (Resubmission)

Doc us

TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System

CLIENT IN US

SCANNING TO INDIA CODING

ACCESSSING SOFTWARE

PATIENT DEMOGRAPHICS ENTRY

CHARGE ENTRY

QUALITY AUDIT

Paid Claims for cash application

TRANSMISSION OF CLAIMS THRU CLEARING HOUSES

Unpaid Claims For corrective action

CASH APPLICATION

AR ANALYSIS / CALLING

CASH TALLYING

ACTION ON DENIALS / REJECTIONS

GENERATION OF REPORTS

REPORTS TO CLIENT

Doc us

TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System

Scanning Documents to India


US Office scans Patient Demographics, Charge Sheets, Insurance Card Copies, etc.

Medical Coding
Log to be maintained with File name, Total charges, Specialty details, etc before Coding.

Scanned copies would be saved as *.TIF (Tagged Image Format) file and placed in FTP Site

Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual.

In the FTP Site, Files would be placed in the common path which can be accessible by India

Coding of Procedures by referring to CPT / HCPCS.

Mail to India on Scan date, File name and directory path.

After Coding, files to be handed over to Charges Department for processing.

Doc us

TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System

Demographics entry
Documents to be sorted Patient wise before entering into the system

Patient Account Numbering to be done, if system does not generate automatically

Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system

If any clarification is required, send mail to US office

After entering, printouts to be taken and data to be checked

Log to be maintained with Total Patients, Patients entered, Pending details, etc.

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TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System


Charge Entry
Patient Demographics and Coding to be done before entering Charges

Charge File to be sorted by Patient / Date of Service

Patient #, Doctor # , Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral , Prior Authorization, On Bill comments, etc. to be entered in the system

If any clarification required, send mail to US office.

After entering data, file to be given to Quality Audit for checking

After checking and corrections, Claims to be transmitted.

After Transmission, Charges completion details to be sent to US office.

If any incorrect details found, Charges department to be informed

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TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System


Quality Check
Quality Audit for Patient Demographics and Charges before sending batch wise update to client

Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File

Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File

After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client. If any incorrect details found, Charges Team to be informed of the same and correction done

Log to be updated with patients checked, charges checked, correction details, etc

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Medical Billing Flow Chart

Revenue Cycle Management System


Claim Transmission Electronic/Paper

After Quality Check is through, List of Electronic Claims to be separated

Transmission processes to be accurately followed to avoid rejection

Claims to be transmitted electronically through different clearing houses

After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc.

If any incorrect details found, Charges department to be informed

Send mail to Charges department after completion of Transmission

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TM

About people, process and technology

Medical Billing Flow Chart

Revenue Cycle Management System


Cash Posting
Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting

Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies

In the EOB Copy, Claim#, Date of Service, Procedure , Units, Charges to be identified before posting

Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting

After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB

If any incorrect details found or any details missing, follow up to be done with Insurance

Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc

Doc us

TM

About people, process and technology

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