Evaluating Your Revenue Cycle: The Typical Billing Process for Medical Clinics

The complexity of the medical billing process can be a detriment to a clinic with an unorganized system. Even one incorrect note or out-of-date record can cause a claim to be denied, which requires more time from the billers to correct and risks the full reimbursement. In general, the typical revenue cycle follows this process:

• The patient calls to make an appointment. If they are a new patient, they should be informed of all the personal information to bring to the appointment or how they can send it beforehand. The front staff should also note the type of appointment they’ve requested so they can properly schedule them if the software has not already done that.
• If the patient has any outstanding bills, they should be informed before they can proceed with a new appointment.
• When the patient arrives, whether they’re new or established, the front staff should ask if their information is all up to date. If not, they should have that information ready before going ahead with the appointment.
• The nurse takes the patient back to their room and reviews their medical history, medications, and the reason why they’re there for the appointment. They also take any vitals at this point.
• The physician or doctor visits next, refers to the nurse’s notes, and documents the meeting with service notes and relevant codes.
• The patient checks in with the front staff before leaving if they have any deductibles to pay or to schedule future appointments.
• All relevant information gets sent to the billing team, whether that’s in-house or outsourced. They review the physician’s notes and ensure the proper codes have been used. They review for any errors and then submit the claim to the insurance. Ideally, it should be accepted and paid in 30 days.
• If the claim is denied, then it goes back to the billing team for another review. They need to ensure the front desk staff entered the correct patient demographics and insurance and the provider used the right codes and procedures so that it can be accepted for the follow-up. The more time spent on correcting denied claims, the more you can get behind in the billing process.

Try to evaluate your process to find where your revenue cycle might be having issues. When you’re in need of a solution, contact the experts at Outsource Receivables Inc. Outsourcing can save you money in many ways—we guarantee our clients save 15% by partnering with our experts.