1. Introduction to the Medical Billing Cycle Chapter One lecture 3 OT 2321
Introduction to the Medical Billing Cycle
Chapter One lecture 3
OT 232

2. 1.8 The Medical Billing Cycle
1-21
A medical insurance specialist is a staff member who handles billing, checks insurance, and processes payments
To complete their duties, medical insurance specialists follow a 10-step medical billing cycle
This cycle is a series of steps that leads to maximum, appropriate, timely payment

3. 1.8 The Medical Billing Cycle (Continued)
1-22
Step 1 – Preregister patients
Step 2 – Establish financial responsibility for visits
Who is primary payer?
Step 3 – Check in patients
Step 4 – Check out patients
A medical coder is a staff member with specialized training who handles diagnostic and procedural coding
The patient’s primary illness is assigned a diagnosis code

4. 1.8 The Medical Billing Cycle (Continued)
1-23
Step 4 – Check out patients (continued)
Each procedure the physician performs is assigned a procedure code
Transactions are entered in a patient ledger—a record of a patient’s financial transactions
Step 5 – Review coding compliance
Compliance means actions that satisfy official requirements
Step 6 – Check billing compliance
Step 7 – Prepare and transmit claims

5. 1.8 The Medical Billing Cycle (Continued)
1-24
Step 8 – Monitor payer adjudication
Accounts receivable (A/R) is the monies owed to a medical practice
Adjudication is the process of examining claims and determining benefits
Step 9 – Generate patient statements
Step 10 – Follow up patient payments and handle collections
A practice management program (PMP) is business software that organizes and stores a medical practice’s financial information

6. 1.9 Working Successfully
1-25
Professionalism is acting for the good of the public and the medical practice
Medical ethics are standards of behavior requiring truthfulness, honesty, and integrity
Thinking it Through, page 29
Etiquette is comprised of the standards of professional behavior

7. 1.10 Moving Ahead
1-26
Certification is the recognition of a superior level of skill by an official organization
Provides evidence to prospective employers that the applicant has demonstrated a superior level of skill on a national test