© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Step 7 in the Medical Billing Cycle: Prepare and Transmit Claims 1-16 Medical practices produce insurance claims to receive payment PMPs generate health care claims for electronic transmittal

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Step 8 in the Medical Billing Cycle: Monitor Payer Adjudication 1-17 When a claim is received by a payer, it is reviewed following a process known as adjudication—a series of steps designed to judge whether it should be paid The document explaining the results of the adjudication process is called a remittance advice (RA) or explanation of benefits (EOB)

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Step 9 in the Medical Billing Cycle: Generate Patient Statements 1-18 A statement lists all services performed, along with the charges for each service Statements list the amount paid by the health plan and the remaining balance that is the responsibility of the patient

© 2011 The McGraw-Hill Companies, Inc. All rights reserved. Step 10 in the Medical Billing Cycle: Follow Up Patient Payments and Handle Collections 1-19 The accounting cycle is the flow of financial transactions in a business PMPs are used to track accounts receivable (AR)—monies that are coming into the practice PMPs are also used to create day sheets, monthly reports, and outstanding balances reports