MEDICAL OFFICE WORKFLOW: HOW YOUR OFFICE CONNECTS

The start of your office workflow begins when a patient schedules an appointment with your office and it ends when all encounters are closed, and all payments have been received. Errors or mistakes in your workflow can lead to your office receiving delayed payments or no payment at all. Medical Coding & Billing is getting increasingly more complicated and having a proper office workflow ensures that billing errors are reduced, reimbursements from the insurance companies are maximized, and patient responsibilities are collected. Everything must connect In-office to have a successful billing workflow.

1. Scheduling

Appointments must be scheduled and communicated effectively. Obtaining patient insurance information via phone and reminding them that payment is due at time of service will help alleviate issues at check in.

2. Billing

Once appointments are scheduled, the billing staff or billing company should keep watch and contact patients’ insurances before their arrival to determine their coverage and costs for the appointment. Contact the patient for a reminder appointment if possible, and make them aware of their copay, deductible, or coinsurance. By performing this step, the patient will be more inclined to arrive prepared to pay for their service without conflict. Always document to make everyone in office aware of patient coverage and communications.

3. Front Desk & Check-In

Front Desk should be aware and prepared to collect patient responsibility upfront. This can be a challenging task, but to make things easier always, let the patient know of any bill or balance at the time of their arrival. ALWAYS COLLECT! If the patient states they are not able to pay the full amount, collect half and ask them when we can expect payment for the remaining balance. Always add a note to their chart so the billing staff or billing company will be aware.

4. Provider

Document, document, document! The provider must be aware of the basic guidelines for each insurance. Proper documentation is key when seeing your patient. Be sure to review Medicare E/M ’95 & ’97 for office visit documentation directions. When you are not sure, always ask your billing staff or billing company  for clarification.

5. Check-Out

Be sure the patient stops at check-out every single visit. This is commonly referred to as a “double-check” system. In case check-In misses something, check-out will be able to catch and resolve any issues. Check-out should also schedule the patient for their next appointment and if necessary, check for any balances that may need collected. This is imperative, if the provider performed additional testing that may affect a high-deductible patient. Always double check so the patient is aware of their costs.

6. Coding & Billing

The coding/billing staff or billing company should be responsible for triple checking and coding/creating claims. There should be a thorough check of the provider’s documentation to ensure it correlates with the claims being submitted to the insurance company. The billing staff or billing company should check for patient balances and if something is missed, contact the patient to make them aware of their balance. The billing staff or billing company should audit all documentation and coding once every 3-6 months depending on size of office.