Tables of Content
- Patient Registration and Insurance Information Collection
- Eligibility and Benefits Verification
- Patient Encounter and Clinical Documentation
- Medical Coding
- Charge Entry
- Claim Creation and Submission
- Payer Adjudication
- Payment Posting
- Denial Management and Appeals
- Patient Billing and Collections
- Accounts Receivable (AR) Follow-Up
- How MedReck BPM Simplifies the Medical Billing Process
- Final Thoughts
Step 1: Patient Registration and Insurance Information Collection
The billing process begins before the patient sees the provider. During registration, patient demographic and insurance information is collected, including:
- Patient name, date of birth, and contact details
- Insurance provider and policy number
- Subscriber information (if different from patient)
Accurate data entry at this stage is critical. Errors in patient information can lead to claim rejections later in the process.
Step 2: Patient Eligibility and Benefits Verification
Before services are provided, insurance eligibility and benefits must be verified. This step confirms:
- Active insurance coverage
- Covered services and exclusions
- Copayments, deductibles, and coinsurance
- Referral or prior authorization requirements
At MedReck BPM, thorough eligibility verification helps prevent avoidable denials and ensures patients are informed of their financial responsibility upfront.
Step 3: Patient Encounter and Clinical Documentation
During the patient visit, healthcare providers document all services rendered. Clinical documentation must be:
- Accurate
- Complete
- Compliant with payer and regulatory guidelines
Detailed documentation supports correct coding and serves as the legal record of care provided.
Step 4: Medical Coding
After the patient visit, documented services are translated into standardized medical codes. This includes:
- CPT codes for procedures and services
- ICD-10 codes for diagnoses
- HCPCS codes for supplies and non-physician services
Correct coding is essential for claim accuracy and compliance. MedReck BPM ensures coding aligns with documentation and payer requirements to reduce audit risks and denials.
Step 5: Charge Entry
Once coding is completed, charges are entered into the billing system. This step involves:
- Assigning charges to appropriate codes
- Verifying provider and service details
- Ensuring accuracy before claim creation
Errors at this stage can directly impact reimbursement.
6: Claim Creation and Submission
Claims are generated using the coded and verified information and submitted to insurance payers electronically or, when required, via paper. Before submission, MedReck BPM performs claim scrubbing to identify and correct:
- Coding inconsistencies
- Missing information
- Payer-specific error
This increases first-pass claim acceptance rates. By leveraging AI medical billing solutions, MedReck BPM enhances claim accuracy, reduces manual errors, and improves first-pass claim acceptance rates.
Step 7: Payer Adjudication
Once received, the insurance payer reviews the claim to determine:
- Coverage eligibility
- Payment amount
- Patient responsibility
The payer may approve the claim, partially pay it, or deny it based on coverage rules and documentation.
Step 8: Payment Posting
After adjudication, payments are received and posted to the patient account. This includes:
- Insurance payments
- Adjustments and write-offs
- Patient responsibility balances
Accurate payment posting ensures financial records remain up to date and transparent.
Step 9: Denial Management and Appeals
If a claim is denied or underpaid, it must be reviewed and corrected. Common reasons include:
- Coding errors
- Missing documentation
- Authorization issues
- Coverage limitations
MedReck BPM proactively manages denials by identifying root causes, submitting corrected claims, and following up with payers to recover revenue.
Step 10: Patient Billing and Collections
After insurance processing, any remaining balance is billed to the patient. Clear and accurate patient statements help:
- Improve patient understanding
- Reduce payment delays
- Increase collection rates
Effective communication is key to maintaining patient satisfaction.
Step 11: Accounts Receivable (AR) Follow-Up
Outstanding claims and patient balances are monitored through AR follow-up. This step ensures:
- Timely resolution of unpaid claims
- Reduced AR days
- Improved cash flow
MedReck BPM uses systematic follow-up strategies to keep revenue moving.
How MedReck BPM Simplifies the Medical Billing Process
MedReck BPM provides end-to-end medical billing services designed to streamline the entire revenue cycle. Our solutions include:
- Patient eligibility verification
- Accurate medical coding
- Clean claim submission
- Denial prevention and management
- Payment posting and AR follow-up
- Real-time reporting and analytics
- HIPAA-compliant data security
By partnering with MedReck BPM, healthcare organizations reduce administrative burden, improve compliance, and achieve faster reimbursements.Our advanced medical billing software enables real-time tracking, automated follow-ups, and detailed financial reporting.
Final Thoughts
The medical billing process -from patient visit to final payment—is complex but manageable with the right expertise and systems in place. Each step plays a vital role in ensuring accurate reimbursement and financial stability. With MedReck BPM as your revenue cycle partner, medical billing becomes more efficient, predictable, and compliant—allowing your team to focus on delivering exceptional patient care.
Frequently Asked Questions
The medical billing process includes collecting patient information, coding services, submitting claims, posting payments, and managing denials and collections.
Proper documentation supports correct coding, ensures compliance, and reduces the risk of claim denials or audits.
The timeline varies by payer, but clean claims typically process faster than those requiring corrections or appeals.
Common causes include eligibility issues, coding errors, missing documentation, and authorization problems.
MedReck BPM uses expert teams, standardized workflows, and proactive follow-up to reduce errors and speed up reimbursements.