What is the procedure of medical billing in New York?

The US government stated the law of HIPAA (Health Insurance Probability and Accountability Act) in 1996 that defines the set of standard medical codes to protect the rights of medical records and other information provided to health care providers. These standards are used to generate medical codes.

Medical billing procedure comprises the following steps:

  1. Patient check-in:

The patient schedules an appointment with the physician and the front office acquires the personal information of the patient like name, DOB, insurance plan information and reason for a visit. This information is recorded and kept safe for the claim submission process.

  • Confirming financial responsibility:

The health care providers acknowledge the insurance coverage, health plan mentioned in the policy number and preauthorize the insurance services in the insurance plan.

  • Patient Check-out:

As soon as the patient receives health care services from the hospital, all of the information on the patient’s treatment is recorded by the medical coders that help the medical billers to generate claims.

  • Coding and billing compliance:

Medical bills are verified that they must contain accurate information for the assurance of clean claim, otherwise, it can result in claim denials.

  • Claim Transmission:

Once the claim is verified to comply with the accuracy measures, they are transmitted to insurance companies. This claim contains the information on diagnosis, treatment and other expenditures of the patients.

  • Billing patients:

If the charges mentioned on the bill are agreed for both of the parties (healthcare providers and co-payers), then the provider receives the claim for the reimbursement.

  • Payment Collection:

When the physicians receive their EOB statement they receive the complete information of the payments.