Medical billing process flow chat

1. Medical Billing Flow Chart
Revenue Cycle Management System
Eligibility
Patient’s coverage is
verified prior to visit
Coding
Medical Records are
reviewed and coded by
Certified Coders
Demographic & Charge Entry
Billingspecialistsenter
patient demographics and
charges into the PMS
Transmission and Posting
Claims are sent to the
clearinghouse and payments
(EOB) received are applied
to the PMS
Accounts Receivable
Increase in collection ratio
through accurate analysis
and timely follow up
Revenue Recovery
Old AR are analyzed and
correctivemeasuresare
taken (Resubmission)
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Hospital
/Doc’s
office
generates
Super bills
Hospital
/Doc’s
office
generates
Super bills
Insurance
Company
Releasing
payments
Insurance
Company
Releasing
payments
Clearing Houses
For
Electronic Clearance
Clearing Houses
For
Electronic Clearance
•Demo Entries
•Charge entries
•Medical Coding
•EOB’s
•Payment Postings
•Denials
•Claims Submission
•A/R Analysis
•Follow up’s
•Insurance Calling
•Patients Statement
•Patient Calling
•Customer Care
•Demo Entries
•Charge entries
•Medical Coding
•EOB’s
•Payment Postings
•Denials
•Claims Submission
•A/R Analysis
•Follow up’s
•Insurance Calling
•Patients Statement
•Patient Calling
•Customer Care
Claims

2. Medical Billing Flow Chart
Revenue Cycle Management System
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ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
REPORTS TO CLIENT
QUALITY AUDIT
GENERATION OF REPORTS
ACTION ON DENIALS / REJECTIONS
TRANSMISSION OF CLAIMS THRU CLEARING HOUSES
CASH APPLICATION AR ANALYSIS / CALLING
CASH TALLYING
CLIENT IN US SCANNING TO INDIA
CODING
Paid Claims for
cash application
Unpaid Claims
For corrective action

3. Medical Billing Flow Chart
Revenue Cycle Management System
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Mail to India on Scan date, File name and
directory path.
US Office scans Patient Demographics,
Charge Sheets, Insurance Card Copies,
etc.
Scanned copies would be saved as *.TIF
(Tagged Image Format) file and placed in
FTP Site
In the FTP Site, Files would be placed in the
common path which can be accessible by
India
Scanning Documents to IndiaScanning Documents to India Medical CodingMedical Coding
Log to be maintained with File name, Total
charges, Specialty details, etc before
Coding.
Coding of Diagnosis to the utmost
specificity using ICD-9 CM Manual.
Coding of Procedures by referring to
CPT / HCPCS.
After Coding, files to be handed over to
Charges Department for processing.

4. Medical Billing Flow Chart
Revenue Cycle Management System
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Patient #, Name(LFM), Address, SSN, Sex, Employer, Home
Ph, Work Ph, Guarantor, Marital Status, Subscriber details,
Doctor#, Insurance information etc to be entered in the
system
After entering, printouts to be taken and data to be
checked
Log to be maintained with Total Patients, Patients
entered, Pending details, etc.
Patient Account Numbering to be done, if system does not
generate automatically
Documents to be sorted Patient wise before entering into
the system
If any clarification is required, send
mail to US office
Demographics entry

5. Medical Billing Flow Chart
Revenue Cycle Management System
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Charge Charge Entry
Patient Demographics and Coding to be done before
entering Charges
Charge File to be sorted by Patient / Date of
Service
Patient #, Doctor # , Place of Service, Type of Service, Dateof
Service, Procedure Code, Diagnosis Code, Modifier, Units, Value,
Referral , Prior Authorization, On Bill comments, etc. to be
entered in the system
After entering data, file to be given to Quality Audit for
checking
After checking and corrections, Claims to be transmitted.
After Transmission, Charges completion details to be sent to US
office.
If any clarification required, send
mail to US office.
If any incorrect details found, Charges
department to be informed

6. Medical Billing Flow Chart
Revenue Cycle Management System
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Quality Audit for Patient Demographics and Charges before
sending batch wise update to client
After Quality Audit, files to be given to Supervisor / Manager
for sending Batch Update to client.
If any incorrect details found,
Charges Team to be informed of
the same and correction done
Date of Service, Procedure Code, Diagnosis Code, Modifier,
Units, Value, Place of Service, Type of Service, Referral,
Prior Authorization, On bill comments, Location, etc to be
checked in Charges File
Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph,
Guarantor, Subscriber details, Employer, etc to be checked
in Patient Demographic File
Log to be updated with patients checked, charges checked,
correction details, etc
Quality Check

7. Medical Billing Flow Chart
Revenue Cycle Management System
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After Quality Check is through, List of Electronic
Claims to be separated
Transmission processes to be accurately
followed to avoid rejection
Claims to be transmitted electronically through
different clearing houses
After transmission, log to be updated with patient
#, claim#, total claims transmitted, pending
claims, etc.
Send mail to Charges department after
completion of Transmission
If any incorrect details found, Charges
department to be informed
Claim Transmission
Electronic/Paper

8. Medical Billing Flow Chart
Revenue Cycle Management System
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If any incorrect details found or any details
missing, follow up to be done with
Insurance
Log to be updated with Total Checks, Total
Value, Posted details, Pending details, etc
After Cash Posting, Claim#, Patient Name and Value
to be checked for tallying data with the EOB
Application of Payment, Deductible, Co-insurance,
Adjustments, Write offs, etc in the Cash Posting
In the EOB Copy, Claim#, Date of Service,
Procedure , Units, Charges to be identified
before posting
Insurance Name, Check #, Total Check Value to
be cross verified with the Check and EOB
Copies
Checks and EOB(Explanation of Benefits) to be
arranged before doing Cash Posting
Cash Posting