Medical Billing

How do the medical billing cycles work?

Your medical billing cycle begins from the moment that you contact your healthcare provider. You can then pre register and give them the basic information that they require such as your insurance and personal identification. You then schedule your appointment.

It’s vital to ask your provider about services, supplies and anything else that you’ll be receiving. If you aren’t sure what to expect you’ll want to have these details of what the insurance covers and what they do not. You should also ask for the procedure codes. Then you should call your insurance company and find out if they cover the services that you’re going to be requiring. You can ask your insurance company what they do and what they don’t cover. You can then get an estimate of what you’re going to owe.

If the amount isn’t something you can manage, you can ask the insurance company if there are other providers in your area that you could go to that would charge less.

Your healthcare provider will contact your insurance company and verify whether or not the insurance company will pre authorize the procedure. Some insurance companies require this and others do not. The insurance company will get the details regarding your appointment, what is going on and your medical records before they decide whether or not to cover the procedure.

Co Pay:¬†Your providers office will let you know how much you’re required to pay out of pocket for your visit.

When you go in for your appointment, you can finish up the final details of your information. You’ll need to bring your insurance card, your ID, your policy information and your group number. This will help the healthcare providers to assure that the insurance information is correct.

All of this information helps the providers to:

Your healthcare provider will then update all of your medical records, any pre existing conditions can determine your coverages.

  • Provide privacy policy information
  • Gain consent for specific procedures
  • Inform you of your care and your liability risks
  • Determine advanced directives which let healthcare providers know what to do if you’re unable to speak
  • Identify the medical codes for prescriptions, all supplies and keep your records up to date.

Healthcare providers create insurance claims with these codes. They submit an 837 file to the insurance company, which is the standard format that is set by the Health Insurance Portability and Accountability Act or HIPAA as it is commonly called. This helps the healthcare facility to communicate with the insurance.

The claims processor works for the insurance provider. This is the person who reviews the claim and verifies that the treatments were covered by your insurance company. The processor may call you to verify specifics regarding your healthcare provider or for more information about what services you received. They will then determine if your claim is valid and either accept or reject it.

The processor will contact the healthcare provider with their decision and if the claim is indeed valid, the insurance company will then reimburse the healthcare provider by giving them a payment for the amount which they will cover. If they reject the claim, the processor will let the billing office know why with a detailed description of the reason that the services aren’t covered and you will be contacted for payment.

Scroll to Top