6 Key Steps of a Successful Medical Billing Process

Medical Billing Process

Medical Billing Process

Scanning medical records make fast and convenient retrieval for medical staff. Medical billing is the procedure of translating medical codes into billable claims that are used to receive reimbursements. Medical billing professionals have to comply with HIPAA regulations in order to prepare accurate claims. A medical claim is completely transited through the whole revenue cycle management. Hence, it prevents redundant procedures from overlapping the schedule and speeds up the claim submission procedure. These effective strategies are used to accelerate the revenue collection cycle drastically.

It is essential to hire medical billing and coding professionals to manage the industrial growth of your business. Physicians should align smart strategies to manage medical billing and coding. The best approach is to outsource medical billing services and focus on their core competencies. Physicians can provide value-based patient care services and improve their practice, simultaneously. While they can also reward themselves with the profitable revenue generation by outsourcing medical billing services. In case, you want to validate your practice and keep everything under control; Follow these six key steps of a successful medical billing process:

1. Patient Check-in

The front-desk staff must collect the demographic information of the patient during preregistration. They should inquire about information about the patient’s insurance plan i.e., the insurance payer and policy number, etc. The staff must collect details about every essential information that is required for a claim submission process.

2. Insurance Eligibility and Verification

Front desk staff must analyze and verify insurance information of every patient before the appointment. Insurance information can be changed at any time, which is why you should verify in advance if their insurance information has changed. A change in insurance information has a significant impact on authorization information on the insurance plan. So it is always worth the trouble of double-checking.

3. Medical Coding of Diagnosis, Procedures, and Modifiers

Medical billing staff should record every service provided by the physicians in a medical code. They should encapsulate every fine detail into standardized codes for accurate medical billing. Accurate coding information is used to describe the patient’s symptoms or illness and define correct treatment and diagnostic procedures. For this purpose, medical coding professionals use the standard guidelines of CPT and HCPCS code modifiers. The healthcare insurance payer can only make an accurate assessment if they contain the correct codes and modifiers.

4. Charge Entry

Charge entry is the procedure of preparing bills for the services that patients received. This step also includes the suitable linking of medical codes to services and procedures provided by the physicians. Charge entry is used to keep track record of every detail of a patient’s visit to the physician’s office.

5. Claims Submission

Once, all the essential data is collected. Then it is used to craft medical billing claims. Medical billing professionals then forward these claims to the relevant insurance payers. Medical billing professionals should consider every variable for each insurance payer in determining how and when to submit a claim. While most of the healthcare insurance companies follow a standard set of guidelines for medical billing, some co-pays follow their regulations of doing things. Medical billers should focus on certain aspects that are payer-specific. They must ensure that they are accurately following their guidelines for claim submission from the medical billing side.

6. Payment Posting

This is the terminating step of a successful medical billing approach. This step involves posting and deposit functions. At this point, the amount that is charged to the patient will be zero if it has been paid in full, or it will reflect the amount owed by the patient. Medical billing companies comply with the health insurance companies according to the guidelines mentioned above. They assist the medical practitioners to boost their financial growth at its fullest potential.


Healthcare practitioners should follow 6 key steps for successful medical billing. The medical billing procedure is started as soon as the patient makes a visit to the physician’s office. Front desk staff collect essential information from the patient during preregistration. Medical billing and coding professionals translate this information into standradized codes. These medical codes are used to generate medical billing claims. Accurate medical claims are forwarded to the insurers for reimbursement.

Related Tag: Factors that Contribute to Success of the Medical Billing Process


Read Previous

Impact of medical billing and coding regulations on the healthcare industry

Read Next

Why are practitioners unable to maintain successful physician billing services in COVID-19 pandemic?

Leave a Reply

Your email address will not be published.