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What is the medical billing cycle?

9/13/2019 7:51:09 AM

It is the process of submitting claims to the insurance company to receive payment of services rendered.

Medical billing starts from the patient’s appointment at the doctor’s office to the time when the doctor’s get detail reports from the account team working at the doctor’s office. When a patient visits the doctor the first thing the doctor would ask the patient if he or she medical insurance to cover the expenses incurred by the physician or the hospital. If the patient has effective medical insurance from a government or commercial company, he or she would give an appointed date on which the patient will receive the service. Because the doctor wants to make sure that insurance will cover the charges that would be incurred in the office of the doctor.

10 steps in the life cycle of medical billing

1. Appointment 

This is the first step in the medical billing cycle when the patient check-in the Facility to get the service from scheduled provider. Appointment can be done by a telephonic call, website or Application. Provider call-in appointed patient for screening and then diagnose with their services. Provider document all performed services with diagnose for patient in his office and transmit these record to Medical billing software/Companies. 

      No-show patients are charged by Provider who cannot come on scheduled time.

Walking patients take appointment from provider office if provider have any free appointment otherwise patient are reschedule for next working day if provider not check walk-in patient on same day. 

2. Eligibility

Eligibility is an important step in the life cycle of medical billing. Eligibility date means the date on which a person becomes eligible for insurance benefits. Provider office verify patient eligibility from different sources like insurance web portal, clearing house system , practice management software and outsourcing,  to check patient active coverage for the date of service rendered. Eligibility includes member name, insurance name, and type of insurance such a medical, dental, or vision. Patient who aren’t enrolled in the health plans, or their insurance coverage is terminated those are self-pay patient and they pay directly for the treatment to the front office.

3. Demographic Entry

After eligibility billing staff will enter the patient data in special software i.e. EHA, eClinicalWorks,  designed for keeping the demographic and health records of the patient. The doctor will also ask the patient some demographic information such as date of birth, name, members SSN, phone number, address and other patient’s information.

4. Decoding

Decoding is a process where rendered services received from different resources (Encounters, Super bills or Progress notes etc.) are converted to diagnoses and procedures using billing software’s for the purpose of transmitting billing.

5Charge Entry

Against each CPT code insurance company has a detail pricing policy on their website for the providers. Medical billing specialist will require that information that they will enter against each CPT code while making a medical claim.

6. Claim submission

As medical billers make a solid claim they will send the claim to the insurance companies electronically, paper or by FAX. They can also mail the claim at the address of the company’s office. Paper claims are faxed to the insurance on a CMS 1500 or UB04 format.

7. Payment posting

Account receivable specialists of the medical billing team would enter the data that they obtain from insurance companies. Insurance companies would also send electronic remittance advice or paper eobs to the medical billing team working at the doctor’s office.

8. Denial Management

Sometimes insurance companies deny the payment of the medical due to several reasons. Account receivable team or specialized team manages the denials that they receive for the claims of the patients of all the different types of insurances.

9. AR Follow up

Account receivable or specialized denial management team will work on the claims that are denied by the insurance companies. They will ask for the reason for the denial and the will do everything in their end to make sure all kinds of faults get remove from the claims to be paid.

10. Reporting

The last step in the medical billing is reporting. AR team executives make detail payment report, claim reports, and denial report to be sent to the doctor’s office. They can also keep problem sheets at their end for further processing. Reporting is the best source to communicate with the doctor office to show the health of a practice.


Bushra Bashir

Human Resource Mangment

10/17/2019 12:51:45 PM

Human resource management (HRM) is the practice of recruiting, hiring, deploying and managing an organization's employees. HRM is often referred to simply as human resources (HR). A company or organization's HR department is usually responsible for creating, putting into effect and overseeing policies governing workers and the relationship of the organization with its employees. The term human resources was first used in the early 1900s, and then more widely in the 1960s, to describe the people who work for the organization, in aggregate.

HRM is really employee management with an emphasis on those employees as assets of the business. In this context, employees are sometimes referred to as human capital. As with other business assets, the goal is to make effective use of employees, reducing risk and maximizing return on investment (ROI).

The modern HR technology term, human capital management (HCM), has come into more frequent use than the term, HRM, with the widespread adoption by large and midsize companies and other organizations of software to manage many HR functions.

Human resource management functions

HRM can be broken down into subsections, typically by pre-employment and employment phases, with an HR manager assigned to each. Different areas of HRM oversight can include the following:

The importance of human resource management

The role of HRM is to manage the people within a workplace to achieve the organization’s mission and reinforce the culture. When done effectively, HR managers can help recruit new professionals that have skills necessary to further the company’s goals as well as aid with the training and development of current employees to meet objectives.

A company is only as good its employees, making HRM a crucial part of maintaining or improving the health of the business. Additionally, HR managers can monitor the state of the job market to help the organization stay competitive. This could include making sure compensation and benefits are fair, events are planned to keep employees from burning out and job roles are adapted based on the market.

Our revenue cycle management services seamlessly fit into your practice. No need for complicated interfaces, expensive start ups costs, or a long term contract. PMTAC's teams of Certified Professional Coders and medical billing reimbursement specialists provide complete medical billing services on your existing EHR software or we can help you switch to the award winning eClinicalWorks EHR suite. We've helped hundreds of practices overcome declining reimbursement, low collections, and high denials. Gain 24/7 transparency into the status of your claims and see how PMTAC's teams of experienced medical billers can increase your revenue.