The medical billing cycle is a complex process that can be challenging to understand and manage for any medical practice. From processing payments to filing and appealing denied claims, a comprehensive medical billing cycle is essential for any healthcare provider to maintain a healthy cash flow.

7 Medical Billing Cycle Steps

Let’s take a look at some of the essential components of the medical billing cycle and explore some tips and strategies to make this process seamless and efficient.

1.  Compiling the Necessary Information

The top step of the medical coding cycle is to collect the necessary insurance information to create an accurate claim. This includes everything from patient demographic, medical history and payment information to clinical details including the type of medical service rendered and the associated fees.

Your medical billers should always strive for accuracy and timeliness to best maximize their chances of having medical claims submitted with accurate information and in a timely manner.

2.  Processing Charges and Documentation

Next, it’s important your practice processes all the charges and associated documents that come with the claim. Depending on the size of your practice and the number of claims you manage each month, it can generally be helpful to outsource this task to a professional medical billing service.

These types of services can play a major role in streamlining the billing process and also help speed up the time it takes to receive payments.

3.  Generating the Claim and Submitting It to the Insurance Company

Following documentation, the next step is to generate the claim and submit it to the insurance company, commonly done electronically by a medical biller. Once the claim is created, it is sent to the insurance company which then reviews the claim to determine its accuracy and verifies the eligibility of the patient’s coverage.

4.  Verifying Insurance Benefits and Determining Reimbursement

The fourth step is to verify the insurance coverage and to work out the total amount of reimbursement that needs to be paid. Once the insurance coverage and reimbursement have been established, the medical provider is notified of the expected amount of payment.

5.  Following-up for Payment

After this it’s crucial for your medical practices’ wellbeing to follow-up for any payments. This includes sending reminder letters and making phone calls to the insurance company to ensure payment is made in a timely manner. While this step may be time-consuming, it is essential to ensure cash flow and patient satisfaction.

6.  Appealing Denied Claims

The sixth step is to appeal denied claims. If a claim is denied, the medical provider must take action and file an appeal. This is one of the more vital steps to take, as it ensures the denied claim is not paid by the patient as out-of-pocket expenses.

7.  Generating Financial Reports

Lastly, your medical practice needs to generate some financial reports to track and measure performance. This kind of report should provide insight into the performance of the practice, patient satisfaction, and the overall financial health of the practice.

Developing Strategies to Help Streamline the Medical Billing Process

By following the above steps of the medical billing cycle, medical providers can ensure their claims are processed as quickly, efficiently, and accurately as possible.

Having said this, there are still some strategies that medical providers can implement to help streamline the whole process.

Digitize your Patient Data

Utilizing electronic medical records is essential for accurate and secure patient data. This can help streamline and automate the medical billing process, making it faster and more efficient.

Outsource the Medical Billing Process

This can be especially beneficial for medical practices that do not have the resources to manage their claims in-house. With a medical billing service, payments are received quickly and accurately, leading to improved cash flow and patient satisfaction.

Automate Recurring Payments

Automating the process of recurring payments can be paramount in the reduction of administrative and operational costs, all while decreasing the manual effort involved in collecting payments.

Review and Adjust Your Billing Process Regularly

The medical billing cycle is ever-evolving, and as such it is vital you review your process and adjust as necessary to ensure accuracy and efficiency.

Working with Medical Billing and Coding Services to Accelerate Your Cash Flow

As your practice grows, it can be difficult to stay on top of your billing cycle. That’s why outsourcing to a reliable and capable medical billing company is essential for success. PMN is the perfect fit for small medical practices. Here’s just a few reasons why:

Accurate and Timely Claims Processing

This is a crucial feature to help ensure your practice receives the maximum reimbursement. PMN provides advanced and efficient claims processing, using up to date technologies, while focusing on data accuracy.

Detailed Revenue Reports

PMN’s comprehensive revenue reports provide a complete picture of practice income and expenses, ensuring that you have the data you need to make sound financial decisions. These reports can help your practice stay organized and plan for the future.

Expert Technical Support

PMN’s support team is always just a message of a phone call away, meaning someone’s always available to quickly answer any questions you may have. They understand the ins-and-outs of the medical billing process, so you can trust that you’re getting the answers you need to make informed decisions.

If you’d like to have a chat to see how PMN can improve your medical billing cycle, contact them today at (949) 215-5055 or by visiting one of their helpful staff members in Laguna Hills, Orange County, California!

FAQs

What Is a Medical Billing Cycle and Why Is It Important?

A medical billing cycle is the process of submitting, tracking and collecting payments for medical services rendered. This process is paramount for the financial health of a medical practice as timely and accurate billing ensures that healthcare providers are reimbursed for the services they provide.

How Often Should I Review My Practice’s Medical Billing Cycle?

It is important to review your medical billing cycle on a regular basis to ensure accuracy and compliance with relevant regulations. We recommend reviewing your cycle at least quarterly, or more often if your patient volume is high.

Are There Any Common Mistakes I Should Be Aware of When It Comes to Medical Billing?

Yes, some of the most common mistakes are billing for services or products not rendered or approved, incorrect or incomplete patient information on medical claim forms, incorrect coding procedures, errors in approving insurance claims, and slow processing of billing payments.