Medical Billing - When The Patient Has To Pay
When we all think of medical billing, we think of the doctor sending your claim off to the Insurance carrier and either having the check sent directly to him, or in some cases, sent to the patient to pay for services rendered.
But what happens when the claim isn't covered?What happens when the patient has to bite the bullet and pay for these services?How does the doctor or facility keep track of this?After all, not everybody has insurance.
In this installment, we'll go over the normal medical billing procedure including some extra things that need to be done to keep track of patient balances.
With most medical billing software packages, you pretty much get everything you need in order to send a claim and receive payment from the carrier.
But what happens when the carrier doesn't pay?What happens to the money?It can't just sit there in the system uncollected.
There has to be some way of finding out what patients end up owing you money.
Well, there is and for the most part, this is how it works.
The software will create what is called an order page.
On that order page will be all the particulars about what is being billed along with the cost.
But the really important part is what is called the payer fields.
You will have one field for primary, one for secondary, one for tertiary and one for patient.
If it's an item that they already know is not covered by insurance, or the patient doesn't have any insurance, the patient field is checked.
If the item is covered, then the payer that is being billed gets checked off.
In most cases, this will be primary.
But in some cases, where the item is only 80% covered by the primary, the secondary insurance will be marked off, if the patient has secondary insurance.
But what if they don't?This is where it gets a little tricky.
What happens is the total is calculated for the primary.
Let's say the item is $100.
The primary gets billed the $80 and the remaining 20%, or $20 goes to the patient owed column.
This way, the software knows that the patient owes this much money for the item that was billed.
Okay, now it comes time to actually bill the patient.
Remember, submitting claims to be paid is not the same as billing a patient.
You are billing the insurance carrier and hoping that they pay.
After payment is made, the balance, if there is one, has to be paid by the patient.
This amount ends up getting transferred to the patient's account.
The next step is to run a report that goes through all the patient accounts to see how much money is owed by each patient.
After the report is run, there is usually an option to print out a bill for each patient.
The proper forms must first be loaded into the printer before doing this.
This is of course very simplified, but basically, this is the procedure that is followed when the patient has to pay for a medical claim.
Yes, medical billing can get quite complicated when insurance doesn't pick up the tab.
But what happens when the claim isn't covered?What happens when the patient has to bite the bullet and pay for these services?How does the doctor or facility keep track of this?After all, not everybody has insurance.
In this installment, we'll go over the normal medical billing procedure including some extra things that need to be done to keep track of patient balances.
With most medical billing software packages, you pretty much get everything you need in order to send a claim and receive payment from the carrier.
But what happens when the carrier doesn't pay?What happens to the money?It can't just sit there in the system uncollected.
There has to be some way of finding out what patients end up owing you money.
Well, there is and for the most part, this is how it works.
The software will create what is called an order page.
On that order page will be all the particulars about what is being billed along with the cost.
But the really important part is what is called the payer fields.
You will have one field for primary, one for secondary, one for tertiary and one for patient.
If it's an item that they already know is not covered by insurance, or the patient doesn't have any insurance, the patient field is checked.
If the item is covered, then the payer that is being billed gets checked off.
In most cases, this will be primary.
But in some cases, where the item is only 80% covered by the primary, the secondary insurance will be marked off, if the patient has secondary insurance.
But what if they don't?This is where it gets a little tricky.
What happens is the total is calculated for the primary.
Let's say the item is $100.
The primary gets billed the $80 and the remaining 20%, or $20 goes to the patient owed column.
This way, the software knows that the patient owes this much money for the item that was billed.
Okay, now it comes time to actually bill the patient.
Remember, submitting claims to be paid is not the same as billing a patient.
You are billing the insurance carrier and hoping that they pay.
After payment is made, the balance, if there is one, has to be paid by the patient.
This amount ends up getting transferred to the patient's account.
The next step is to run a report that goes through all the patient accounts to see how much money is owed by each patient.
After the report is run, there is usually an option to print out a bill for each patient.
The proper forms must first be loaded into the printer before doing this.
This is of course very simplified, but basically, this is the procedure that is followed when the patient has to pay for a medical claim.
Yes, medical billing can get quite complicated when insurance doesn't pick up the tab.
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