I am sometimes asked what are the basic steps in processing medical billing claims. This is actually a very good question for a new student to ask. Below are the general steps in medical billing claims processing.
Basic Claims Processing Steps for Medical Billing Online Courses
- Check each claim for any possible errors or omissions. Are all blocks of the form filled out properly?
- Did you attach any necessary information that should be attached to the form. If a procedure or service is “out of the ordinary” “took extra time,” etc. It’s always a good idea to attach documentation supporting it.
- If the insurance company requires it, make sure the doctor signature is on the claim.
- Post to the patient’s account ledger the submission of the claim (this is all done via software).
- Place a copy of the claim in the claims files.
- Submit the claim to the health insurance company/payer.
What happens next? When the remittance advice is received by the health insurance company, you must review the claim to make sure that payment is correct. Make a note of the RA (remittance advice) batch # on the claim itself so it can be cross-referenced easily. Mark the claim closed if it’s paid in full. If there are error then we must fix them and resubmit the claim for processing. You would do this by writing an appeal for reconsideration of payment. Make a copy of the original claim, the RA notice, and the appeal you wrote.
Generate a NEW CMS-1500 claim, and attach it to the RA notice and appeal. Double check the date in block 31 that it matches the ORIGINAL claim. Mail the appeal to the payer.
Following up on denied claims by fixing errors and writing appeals is key to successful medical billing and reimbursement.
By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training? Check out Medical Billing Online Courses
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