Before Sending Claims
Before filing a claim for the encounter with the patient, there are certain authorizations that must be obtained and information collected:
- Provider (physician) must be credentialed with insurance payers.
- Provider must be enrolled with insurance companies to send claims electronically.
- Patient personal information collected.
- Patient insurance information collected.
- Patient authorization for provider to submit claims on their behalf.
Practice Management Software Setup
Just about every healthcare provider uses a practice management software to manage their practice. There are hundreds available. Practice management and medical billing software are used interchangeably. Just about all of them can perform the same basic functions:
- Scheduling patient visits
- Managing patient accounts
- Creating insurance claims
- Recording insurance and patient payments
- Creating patient statements
- Tracking claim status
Example of Provider Setup Screen
Collecting Patient Information
In addition to setting up a provider, the patient information needed for filing claims must be collected. Below is an example of the patient information form used on the first patient visit.
Patient Insurance Information
Most of the necessary patient insurance information is contained on their insurance card. Below is an example of the Blue Cross insurance card.
- The most important form in medical billing in both its paper and electronic form.
- Contains all the information from the patient encounter in one form.
- The CMS-1500 form was developed by the National Uniform Claim Committee (NUCC).
- NUCC is responsible for standardizing instructions for completion of the form.
Patient Information Screen Example in Practice Management Software
Example of Patient Encounter (Visit) Screens in Practice Management Software
Below is the screen in the practice management software that includes the details of the visit. This is where the diagnosis and treatment codes are entered.
The following forms are required on the first patient visit to obtain all the necessary information and authorization to bill for the visit:
- Patient Information which includes Insurance, Guarantor, Assignment of Benefits, Payment Authorization
- Authorization for Release of Medical Information
- Patient Medical History
- Payment Policy
- HIPAA Communication Disclosure