The medical billing and coding process involves numerous tasks completed by all staff members of a medical facility to provide quality care while protecting the privacy of patients and expediting the payment of services. Ten steps are used to complete this process; pre-registration of patients, establishing financial responsibility for visits, check in of patients, check out of patients, review of coding compliance, a check of billing compliance, preparation and transmittal of claims, monitoring payer adjudication, generating patient statements and handling collections.
During pre-registration, HIPAA policies are reviewed and signed by the patient to inform him or her of their rights and responsibilities; therefore, informing the patient of specific processes necessary for transmitting claims and the facilities devotion to confidentiality. This step also uses careful HIPAA measures to retrieve demographic and insurance information and schedule or update appointments in a manner that protects the patient’s privacy.
During the steps of establishing financial responsibility, patient check in, and patient check out staff members follow HIPPA regulations to review demographic, medical, financial, insurance cards, and necessary authorizations in a manner that prevents unauthorized individuals the access to information that may be used in a negative manner to harm the patient. During check out three digit diagnosis codes from the ICD and five digit CPT codes, are added to the super bill to identify treatments, procedures, and injections or immunizations. These may include two digit modifiers, subcategories or classifications, and V or E codes.
HCPCS codes are only used when the services apply to hospital treatments for outpatient services. Every code provides easily identifiable information that designates specific circumstances needed for documentation to acquire timely and appropriate payment for services. Finally, the final steps to review coding and billing compliance for preparing and transmitting the claim ensure billing rules follow HIPAA and payer rules for proper ICD, CPT, and HCPCS coding that maintains patient confidentiality, promotes integrity, and avoids any delay in payments.