What Is the Process of Medical Billing?

By | August 21, 2021

As a medical practitioner or facility, it is important to know how to bill for medical services. Understanding this process can bring plenty of benefits and ease the whole workflow in your clinic. If you want to acknowledge what medical billing services are and how to optimize them, then stay here, as we have compiled this article to break down the steps in an easy and straightforward manner.

Registration of patients

It goes without saying that the first step should be the registration of your patient into your system. Every new patient should provide personal information as well as insurance information that will make them eligible to receive services from your facility. If the patient is recurrent, then their information should be already in the system.

Confirmation of Financial Responsibility

Planting trees on a coin pile with sunlight to save money, saving and investment ideas or future financial planning, ideas for business, innovation, growth and money.

It is your responsibility to determine which services are covered by the patient’s plan. You should not take the patient’s word for it. The coverage of insurance will differ depending on the individual, company, and payment plan. There could be certain prescription medications and services that are not covered. And if that’s the case, you should make the patient aware of this.

Check-in and check-out

This step of the process is straightforward. Upon arrival, it is required that the patient will fill some forms. They also will need to provide identification. This could be in the form of a passport or driver’s license. They will also need to present a valid insurance card. Co-payments are also collected. However, it is up to the service provider to determine whether this is before or after the visit.

After check-out, the medical coder receives the patient’s information and service rendered. This will be translated into the appropriate medical code. This is known as the ‘superbill.’

Claim preparation

You will receive the ‘superbill’ from the medical coder. Before sending it to the payer, remember to add the costs of the procedure to the claim and to recheck the medical codes. Also, ensure that the bill follows the provisions given by the Health Insurance Portability and Accountability Act, HIPAA.

Transmission of Claims

The HIPAA asks that all claims should be submitted electronically unless under certain circumstances. You may choose to use manual claims, but we wouldn’t recommend that due to the longer response time between payers and service providers. Manual submissions also may contain errors.


Adjudication involves the evaluation of your medical claim by the payer. The payer will assess whether your claim to the medical service is valid, complies to set regulations and provisions, and how much you should be paid. This is the stage that determines whether your claim will be denied, accepted, or rejected.

Once the adjudication is complete, the payer will get in contact with you, detailing how much they will pay you. In some cases, this can differ from what you had requested.

Generation of patient statements

The patient statement is the bill sent from the provider, detailing the procedures and costs. It separates as well what the payer has agreed to pay and what the patient should pay.

Follow up

The last step is following through and ensuring that all bills are paid. And once a bill is paid, accurate medical records should be filed in the patient’s records.