All You Need To Know About The Medical Billing Process

Medical billing is a payment process used in the United States medical system. In the practice, medical practitioners fill patient forms and submit them to health insurance companies to claim payment for health services rendered. The cycle ensures that the patient, doctor, and health insurance provider are correctly paid and credited. This means that either the patient or insurance company will pay the medical bill.

Since medical billing could take anywhere from a few days to several months, it can get frustrating. Understanding the entire process and what’s involved in each step will go a long way toward easing the stress. Here’s what you should know.

1. Get the patient’s details

It is important to record and store all patient data to make it easier to seek compensation from insurance companies. This is quite straight forward. When the patient arrives, hand them a registration form to fill all necessary information. Then make a ‘back and front’ copy of their insurance card before creating an account. Finally, input the provided details in electronic storage.

To ensure that a patient’s data is entered and stored safely, you could use reliable medical billing software for billing companies. OpenEMR is common software used by healthcare providers. Several OpenEMR reviews show that the medical management software is popular among healthcare providers. It’s certified by relevant bodies and integrates medical records and practice management for the service providers. It also helps with scheduling and billing. This should make it easier to retrieve the information when needed.

2. Confirm that the patient is insured

Confirm that the patient is insured before they get into an examination room. You’ll need their name, date of birth and policy number. Then call the health insurance provider and ask them to verify the coverage. They’ll also ask several questions to check if the claim is genuine. Once you are done, request them to fax you a copy so that you can keep it for future use.

3. The doctor should fill the encounter form

Make sure that the doctor provides details of the examination procedure and the diagnosis. Important information includes the date of the exam, patient’s name, and their reference number. Most forms also ask for the place where the examination or treatment took place, the list of procedures conducted on the patient, and the amount billed for them. It is also important for the doctor to sign the form to confirm the authenticity of the document.

4. Code the information

Look at the doctor’s form to identify the diagnosis made after the examination. Then code the information. You will need a special code book to correctly code the diagnosis or displayed symptoms. You can get most of this information from the encounter form and special code books.

The diagnosis codes let the insurance provider know what the patient was suffering from and what treatment was rendered. The insurance provider then reviews the codes before making payment. The two main coding texts are ICD-9 (a code describing diagnosis) and CPT (a code describing procedures).

5. Record demographic information

This should be easy to do since most of the information is already stored in your system. All you need to do is to open the patient’s registration form and input additional information such as their guarantor, employer or phone number. Information on the type of plan and the name of their spouse or parent is equally important.

6. Charge entry

Open the medical billing software for billing companies and look for relevant information on the patient. Then enter their reference number, medical procedures conducted, diagnosis and medical insurance company to be billed. Before saving the information, check to find out if you have entered all the required information correctly.

7. You can now submit the claim

Since different health insurance companies have different procedures, call the patient’s insurance provider to check their requirements. Most of them ask for paper or electronic submissions. Electronic claims tend to be efficient though. OpenEMR review indicates that healthcare providers who use the software can easily find required information and submit it to an insurance company. Charges are typically billed on three main forms. These are the UB-04 (used in inpatient settings), UB-92 (for dental visits) and CMS-1500 (for billing other medical claims).

8. Receive reimbursement

Reimbursements are the benefits that a patient is entitled to. The claims cover examinations, supplies, and laboratory services among other procedures performed on a patient. After sending the claim form, health care providers track and follow up the claims to ensure they receive full payment from the health insurance company. After receiving payment, check your records to verify that the insurance provider paid the correct sum. If there is an outstanding balance, the patients are asked to pay the remaining balance or make an appeal. To avoid such a situation, advise patients to read and understand terms and conditions of the insurance company. Some providers only pay for medical services offered in specific hospitals or by particular doctors. Some also put a cap on the amount payable for medical procedures.


The medical billing process will be a lot easier if you have a reliable electronic system where you can store all patient data. If you do not currently have one, you can download the OpenEMR free of charge. Over 7,000 facilities download this software and use it for storing medical records. The software is also undergoing efforts to provide services in several languages across different countries.


Those Dewolfes is going to continue to be your place to find your software needs without falling into the shiny object syndrome.

It’s important that you get access to the right computer tools, hardware, software and other accessories to make sure that you get the job done right when you are dealing with your customers.

Our new database should be up shortly where you should then be able to make a decision on which direction you want to take!