Summary of Ten Steps of the Billing Process and Procedures Essay

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1. Summary of ten steps of the billing processes and procedures. (explain each process) In addition include: a. Content and use of Registration or Encounter Forms, b. Explanation of Benefits (EOB), and Remittance Advice (RA), c. Advance Beneficiary Notice (ABN), d. Participation Contracts, e. The adjudication process for payers and providers. A. Pre-registering patients: The main function of the first step is to schedule and update appointments as well as gather personal and insurance information about new and existing patients. New patients provide personal and insurance information to the scheduler, and pre-existing patients update any personal or insurance information with the practice that has changed. B. Establishing financial…show more content…
An ABN will be presented to a patient to sign if the provider believes the procedure or treatment will not be covered by Medicare because it is not reasonable or necessary. The patient will be advised of this before the procedure or treatment begins, giving them the option of whether or not to follow through with the encounter. D. Check out patients: In this step, diagnoses and procedures are recorded and assigned a medical code, which is recorded on an encounter form by the physician or the billing specialist. An encounter form is used to record the services provided by the practice. Encounter forms are also known as charge slips, routing slips, and superbills. Encounter forms list the practice’s most performed procedures and corresponding codes (fee schedules) for easy filing, as well as any insurance companies under contract with the practice. Previous balances, coinsurance, deductibles and fees for uncovered services are also listed on the encounter form and brought to the patient’s attention. Upon payment of the patient’s balance, the patient is scheduled for any follow-up visits. Any scheduled follow-up visits are also listed on the encounter form. E. Review coding compliance: In this step, following official guidelines for codes is imperative, as well as double-checking the assigned diagnostic and procedural codes for errors. The insurance company must understand the reason for
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