The process begins when a patient schedules an appointment. Initial demographic and insurance information is collected during this step.

The patient’s personal and insurance details are recorded or updated when they arrive for their visit. This is crucial for accurate billing and claim processing.

The healthcare provider confirms the patient’s insurance coverage and eligibility for the services being provided.

After the patient encounter, the services, treatments, and diagnoses are translated into standardized medical codes (e.g., ICD-10, CPT). Charge capture involves accurately recording all billable services into the billing system.

Accurate and thorough documentation of the patient visit and services provided is essential, as the medical coder uses these records to assign the correct rules.

Once the services are coded and charges entered, a medical claim is prepared and submitted to the patient’s insurance company for reimbursement. Claims are often “scrubbed” for errors before submission to prevent rejection.

After the insurance company processes the claim and pays it portion, any remaining balance (deductibles, co-insurance, or non-covered services) is billed to the patient. The provider’s office then follows up to collect these outstanding patient payments