Medical Classification and Medical Billing Process

Custom Student Mr. Teacher ENG 1001-04 28 December 2016

Medical Classification and Medical Billing Process

The ten steps in the medical billing process are divided into three sections and they are: visit, claim, and post claim. The visit has four steps and they are: preregister patients, establish financial responsibility for the visit, check in patients, and check out patients. The claim has three steps and they are: review coding compliance, check billing compliance, prepare and transmit claims. The last section is the post claim which has the last three steps which are: monitor payer adjudication, generate patient statements, and follow up on patient payments and handle collections. HIPAA, ICD, CPT, and HCPCS, all have an important role in the medical billing process. HIPAA protect any information in which individuals can identify the patient, their health and history, such as their name, social security number, contact and billing information, and insurance.

When first visiting the medical facility a patient must receive a notice of privacy, this will explain how to exercise his or her rights under HIPAA. It will protect patient records from being disclosed without his or her consent. In the medical billing process, HIPAA influences preregistering because the staff must make sure the patient information is not overheard by others in the waiting room. HIPAA also influences the establishing’s financial responsibility because the patient provides the medical facility with his or hers personal information as well as insurances. International Classification of Disease (ICD) is diagnosis codes used at check out time to identify the patient’s primary illness. In order for the visit to be bill the physician must put down a medical code to describe the patient medical diagnoses and procedures.

When the physician performs a treatment or test a procedure code is assigned. These codes can be selected from the CPT or Current Procedural Terminology. Any service in which is not included in the CPT can be found in the HCPCS or the Healthcare Common Procedure Coding System. HIPAA has made HCPCS codes mandatory for billing and coding. HCPCS codes are for patients in Medicaid, Medicare, and private insurance plans. Once the services is provided and the ICD, CPT, and HCPCS codes are assigned then the medical facility can submit the claim to the insurance provider. By not putting the right codes down it can cause the claim to be denied. The medical coder will then have to resubmit the claim so the bill can be process and paid.

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  • Subject:

  • University/College: University of California

  • Type of paper: Thesis/Dissertation Chapter

  • Date: 28 December 2016

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