The billing workflow

The billing workflow is a simple step-wise process that guides the healthcare professionals when seeking reimbursement from insurance companies. Therefore, it is necessary that healthcare workers are mindful of these steps to allow an easy transition towards reimbursing payment. One of the steps that are an imperative constituent of this workflow is the ability of healthcare providers to verify the eligibility of a patient’s insurance care plan at the first visit or in subsequent visits. Verification is an imperative process during reimbursement of care given because a provider can determine the kind of insurance plan under which the patient is covered because different health insurance plans have different provisions. Subsequently, the provider can notify the patient about his or her care plan and the type of services for which reimbursement by the insurance company is possible. To avoid confusion, it is important that the providers informs the patient of copays and collects it during the visit, and it can be either before or after the patient gets the service.
Once the patient has been treated and has filled in all the required information, the provider prepares a paper claim form that is to be sent to the insurance company. The claim form should be valid, indicating the mount that is to be paid about the type of diagnosis, service given and a justification for the service provided. Accurately and clearly indicating the patient information, including demographic and medical history, the procedures performed where each procedure is paired with a diagnosis code to indicate the need or justify the treatment given, and price for each service is paramount.

All this information helps the payer (insurance company) to determine whether the information provided conforms to the patient’s insurance plan and laid out regulations before reimbursement can be issued. Otherwise, the paper claim might not be processed for reimbursement; instead, it might be sent back to the provider. Failure to prepare a valid claim form delays reimbursement, and there is wastage of time as the provider tries to make corrections, and this might involve making phone calls to the patient and requesting them to come over.