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Billing Flow Chart

The document outlines the steps involved in the revenue cycle, including appointment scheduling, eligibility determination, patient visits, claims transmission, and payment posting. It details the responsibilities of staff in demographic entry, charge capture, denial management, and follow-up on outstanding claims. Additionally, it emphasizes the importance of communication and coordination with clients and other staff members to resolve issues effectively.

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Saeed ahmed
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526 views4 pages

Billing Flow Chart

The document outlines the steps involved in the revenue cycle, including appointment scheduling, eligibility determination, patient visits, claims transmission, and payment posting. It details the responsibilities of staff in demographic entry, charge capture, denial management, and follow-up on outstanding claims. Additionally, it emphasizes the importance of communication and coordination with clients and other staff members to resolve issues effectively.

Uploaded by

Saeed ahmed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Revenue Cycle

Appointment Scheduling Eligibility determination Patient Visit


• Phone Call • Verification of coverage and benefits • Demographics
• Online from web • Referral • Patient payment (Copay etc.)
• Personal Health Record • Prior Authorization • Exam
• Diagnoses & Procedures

Monitoring rejections Claims Transmission Charge Capture


• First Level • Electronic • Electronic
• Clearing House • Direct Submission • EHR
• Second Level • Indirect submission • Interface
• Commercial Insurance • Paper • Paper
• Direct • Superbill (E-Bridge or FTP)

Payment Posting Denial Management Patient Billing or Secondary


• Electronic Remittance Advice AR Follow up Claims
• Explanation of Benefits (Manual • Patient Billing for liability
Posting) (FTP or E-Bridge) • Taking corrective actions on denials
• Billing to secondary insurance
• Working on aged claims
Your Role in the Revenue Cycle

Demographic entry: To enter patient information in the system as you receive it on the face
sheet or registration form.

Charge capture: To create claims in the system timely and with 100% accuracy.

Payment Posting: Ensure payments received via ERA, EOB, Cash Register, secure support
message, email or from a payer portal are posted into the system with 100% accuracy.

Denial management: To take corrective action on the denials in order to get the
reimbursement in the next payment cycle.
Your Role in the Revenue Cycle

AR Follow Up: You will need to follow up daily on the outstanding claims which are
outstanding.

Appeals and correspondence: To work on correspondence/letters sent by insurance carriers


and to appeal on incorrectly denied claims.

Communication with client and their staff: Daily, weekly, monthly communication via
telephone, secure messaging, or video conference

Coordinating with other MTBC staff: Depending on the situation you may need to work with
IT, Credentialing, Client relations, ETC to resolve any outstanding issues with the provider you
are working with.

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