Kootenai | Kootenai Health | Issue 3, 2017

Medical Billing Cycle Referral. A physician, nurse practitioner or physician assistant refers a patient for care with a specialist, hospital or laboratory. Scheduling. The hospital or clinic providing the care schedules the appointment for the patient. The patient’s basic demographic information (name, date of birth, insurance if available, etc.) is entered into the electronic health record system. Preregistration. For prescheduled services, this process verifies the patient’s insurance benefits and financial obligation. The patient is provided an out-of- pocket estimate prior to care. Financial counseling. Services are always provided, regardless of the patient’s ability to pay. Financial counseling and assistance is offered to the patient if he or she cannot pay for the service up-front. Registration. This face-to-face check-in is to validate the patient’s information and that the patient received the preregistration call. For walk-in patients, this time is used to gather and verify their personal information and insurance. By Andrea Nagel In the world of health care , few processes are more complex than billing. Driven by physician documentation, insurance coverage and government regulations, it’s difficult for the average person to fully understand the bill that arrives in the mail. Aside from the bill itself, patients are also expected to understand what their health plan covers and the difference between co-pays, deductibles, out-of-pocket expenses and co-insurance. “Every benefit plan has its own nuances,” said Kathleen Dahlgren, executive director of Kootenai’s revenue cycle. “Each plan has different descriptions and criteria for doctor visits, testing, procedures and just about everything else that a pa- tient would encounter throughout the health care process.” Even though not everyone can be a medical billing expert, it is important for patients to be familiar with the process, the terminology and their insurance plan. Here is an overview of the steps in a typical medical billing cycle. r s U n d e t a n d There’s more to medical billing than meets the eye YOURBILL MEDICAL BILLING 16