Medical Billing Flow Chart
Revenue Cycle Management System
Eligibility
Patient’s
coverage
verified prior to visit
is
Clearing
ClearingHouses
Houses
For
For
Electronic
ElectronicClearance
Clearance
Coding
Medical
Records
are
reviewed and coded by
Certified Coders
Demographic & Charge Entry
Billing
specialists
enter
patient demographics and
charges into the PMS
Transmission and Posting
Claims are sent to the
clearinghouse and payments
(EOB) received are applied
to the PMS
Accounts Receivable
Increase in collection ratio
through accurate analysis
and timely follow up
Hospital
Hospital
/Doc’s
/Doc’s
office
office
generates
generates
Super
Superbills
bills
•Demo
•DemoEntries
Entries
•Charge
•Chargeentries
entries
•Medical
Coding
•Medical Coding
•EOB’s
•EOB’s
•Payment
•PaymentPostings
Postings
•Denials
•Denials
•Claims
•ClaimsSubmission
Submission
•A/R
Analysis
•A/R Analysis
•Follow
•Followup’s
up’s
•Insurance
•InsuranceCalling
Calling
•Patients
Statement
•Patients Statement
•Patient
•PatientCalling
Calling
•Customer
•CustomerCare
Care
Claims
Insurance
Insurance
Company
Company
Releasing
Releasing
payments
payments
Revenue Recovery
Old AR are analyzed and
corrective measures are
taken (Resubmission)
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Medical Billing Flow Chart
Revenue Cycle Management System
SCANNING TO INDIA
CLIENT IN US
CODING
ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
QUALITY AUDIT
Paid Claims for
cash application
TRANSMISSION OF CLAIMS THRU CLEARING HOUSES
CASH APPLICATION
Unpaid Claims
For corrective action
AR ANALYSIS / CALLING
CASH TALLYING
ACTION ON DENIALS / REJECTIONS
GENERATION OF REPORTS
REPORTS TO CLIENT
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Medical Billing Flow Chart
Revenue Cycle Management System
Scanning Documents to India
US Office scans Patient Demographics,
Charge Sheets, Insurance Card Copies,
etc.
Scanned copies would be saved as *.TIF
(Tagged Image Format) file and placed in
FTP Site
In the FTP Site, Files would be placed in the
common path which can be accessible by
India
Mail to India on Scan date, File name and
directory path.
Medical Coding
Log to be maintained with File name, Total
charges, Specialty details, etc before
Coding.
Coding of Diagnosis to the utmost
specificity using ICD-9 CM Manual.
Coding of Procedures by referring to
CPT / HCPCS.
After Coding, files to be handed over to
Charges Department for processing.
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Medical Billing Flow Chart
Revenue Cycle Management System
Demographics entry
Documents to be sorted Patient wise before entering into
the system
Patient Account Numbering to be done, if system does not
generate automatically
Patient #, Name(LFM), Address, SSN, Sex, Employer, Home
Ph, Work Ph, Guarantor, Marital Status, Subscriber details,
Doctor#, Insurance information etc to be entered in the
system
If any clarification is required, send
mail to US office
After entering, printouts to be taken and data to be
checked
Log to be maintained with Total Patients, Patients
entered, Pending details, etc.
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Medical Billing Flow Chart
Revenue Cycle Management System
Charge Entry
Patient Demographics and Coding to be done before
entering Charges
Charge File to be sorted by Patient / Date of
Service
Patient #, Doctor # , Place of Service, Type of Service, Date of
Service, Procedure Code, Diagnosis Code, Modifier, Units, Value,
Referral , Prior Authorization,
On Bill comments, etc. to be
entered in the system
If any clarification required, send
mail to US office.
After entering data, file to be given to Quality Audit for
checking
After checking and corrections, Claims to be transmitted.
After Transmission, Charges completion details to be sent to US
office.
If any incorrect details found, Charges
department to be informed
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Medical Billing Flow Chart
Revenue Cycle Management System
Quality Check
Quality Audit for Patient Demographics and Charges before
sending batch wise update to client
Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph,
Guarantor, Subscriber details, Employer, etc to be checked
in Patient Demographic File
Date of Service, Procedure Code, Diagnosis Code, Modifier,
Units, Value, Place of Service, Type of Service, Referral,
Prior Authorization, On bill comments, Location, etc to be
checked in Charges File
After Quality Audit, files to be given to Supervisor / Manager
for sending Batch Update to client.
Log to be updated with patients checked, charges checked,
correction details, etc
If any incorrect details found,
Charges Team to be informed of
the same and correction done
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Medical Billing Flow Chart
Revenue Cycle Management System
Claim Transmission
Electronic/Paper
After Quality Check is through, List of Electronic
Claims to be separated
Transmission processes to be accurately
followed to avoid rejection
Claims to be transmitted electronically through
different clearing houses
After transmission, log to be updated with patient
#, claim#, total claims transmitted, pending
claims, etc.
If any incorrect details found, Charges
department to be informed
Send mail to Charges department after
completion of Transmission
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Medical Billing Flow Chart
Revenue Cycle Management System
Cash Posting
Checks and EOB(Explanation of Benefits) to be
arranged before doing Cash Posting
Insurance Name, Check #, Total Check Value to
be cross verified with the Check and EOB
Copies
In the EOB Copy, Claim#, Date of Service,
Procedure , Units, Charges to be identified
before posting
Application of Payment, Deductible, Co-insurance,
Adjustments, Write offs, etc in the Cash Posting
After Cash Posting, Claim#, Patient Name and Value
to be checked for tallying data with the EOB
If any incorrect details found or any details
missing, follow up to be done with
Insurance
Log to be updated with Total Checks, Total
Value, Posted details, Pending details, etc
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