Hospital Billing Process 101: What You Need To Know

The term “Hospital Billing” or “Medical Billing” might seem like a complex term, but in actuality, it isn’t. In a nutshell, it is a process of collecting revenue from insurance companies on behalf of the patient in return for the healthcare service provided. But from patient appointment booking to payment collection, the hospital billing passes over a number of steps in order to organize all the operations. Today, you’ll know these steps in detail and what are the main roles achieved in each step.

Importance Of Hospital Billing

In order to learn about the hospital billing process, you must first know its importance, how it is performed, and what are the challenges you will face during revenue cycle management billing. 

As most of the medical sectors implement technology in their billing services, payment procedures too went automated and for that RCM software is commonly employed. Automation keeps all patient information collected. 

Before submitting claims to the payer, patient eligibility has to be verified in order to represent the claim as an authentic application. So, RCM software makes sure to verify the patient and head towards submitting the claim.

When we talk about submitting claims during hospital billing, we mean submitting proper claim applications. That means you have to make the application free from any sort of blunder. Because every minor to major mistake or misleading information is identified by the payer and the claim can be rejected, that can make the process lengthier. Software that is used during the process thoroughly examines the claim and submits it as a 100% credible application. 

Additionally, hospital billing performed through automation ensures timely payment from insurance organizations and patients, which can be much more difficult to execute manually. If the process is not automated, you are likely to miss out on the chances of quick payment. As some patients are slow in paying their bills, but automation lets them do it promptly. 

The above points show how much hospital billing is important to conduct through automation.

Steps Involved In Medical Billing

The hospital billing process constitutes 8 basic steps, starting from registering the patient to getting the reimbursement in the bank. A quick overview of the steps are:

Enrolling: Registering the patient

Financial Coverage: Checking the patient’s insurance amount

Patient Check-in: Collecting information

Claim Preparation: Based on the details, the claim application is prepared

Submission: The claim application is submitted

Insurance Provider’s Role: The payer will verify the claim

Patient Billing: Applicable bills are collected from the patient

Revenue Collection: The reimbursement payment is received

1. Enrolling

As soon as the patient books an appointment, your staff is required to collect their information including personal address and insurance details. Further specifics can be taken when the patient visits the clinic, but most of the work has to be done in advance if you want to save time.

If there’s a patient that has already taken any health service from your clinic in the past, then most probably you’ll have their data. Confirm that again with the patient, just in case he has switched his location or insurance company.

2. Financial Coverage

In this step, you must make sure of the patient’s insurance payment coverage. Evaluate how much of the insurance sum is left in the patient’s plan in order to estimate the medical cost in advance. 

It is also crucial to keep the payment estimation process transparent. That means, disclosing all the payment information to the patient and telling them how much they will be required to pay for the treatment.

3. Patient Check-In

When the patient visits your clinic physically, some other documents are required to be obtained from them at the moment, i.e insurance card, driving license, etc.

 Another procedure you have to conduct during a patient visit is that collect co-payments (payments made by the patient for the medical services). You must collect the co-payment at the time of the patient visit otherwise after check out the process could be dragged on for a longer period.

Then the information is sent to the medical coder for charge capturing, where the code is identified according to the service taken by the patient.

4. Claim Preparation

After all the materials are gathered from the patient, now is the time to prepare claims and complete the application with authentic details. During the whole hospital billing process, this is the step that decides your revenue generation future. You must prepare the claim application following the payer guidelines, with all the correct information.

It is also a good idea to re-check the claim thoroughly to avoid future inconvenience in the form of claim denials.

5. Submitting Claims

When the application is prepared and made to comply with claim accepting procedures, you can submit it to the payer. Mostly, automated systems are used for claim submission. Without automation, this process can become a headache as you have to keep a regular follow-up with the claim application and manually that’s almost impossible.

Besides, regularly monitor the claim status, whether it is accepted by the payer or rejected due to any mistake he discovered.

6. Insurance Provider’s Task

Here the payer is the protagonist. He will check out the claim applications, their credibility, patients’ information, and such. After this, the deciding stage comes up, in which either he accepts or rejects the claim.

If the claim is accepted, you’ll get the reimbursement payment, but if the application is rejected the payer will return the claim along with identifying the problem. Don’t be disappointed when it happens, as many practitioners face this problem during hospital billing. All you have to do now is resolve the payer objection and re-submit the claim.

7. Patient Billing

If fortunately your claim is accepted, now you have to send the medical bill to the patient with the remaining payable amount. 

For this, you have to prepare a document, EOB (Explanation of Benefits), and send it to the patient. EOB covers all the expenditures that the insurance company has paid and the remaining cost that the patient has to bear, back up your statements with evidence and necessary documents.

8. Final Step – Receiving The Payment

When all the billing work has been done, the patient will pay for the services and you will get the payment. But some clients are unable to pay bills quickly, in that case, have a discussion with them and make sure of a quick turnaround.

Wrapping Up

By studying these 8 steps involved in hospital billing, you are now ready to conduct the process or even try to get associated with the RCM industry. However, to get the most out of it, make sure to utilize advanced and reliable revenue cycle software, that will boost your capacity of generating revenue.