Understand the Medical Billing and Coding Process | Career Training | The Salter School
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Understand the Medical Billing and Coding Process

Category(ies): Health Claims Specialist / Medical Billing and Coding

medical billing and coding health claims processYou can help play an important role in healthcare

If you’re training to become a medical billing and coding specialist, it’s important to understand the process that each medical claim goes through, as part of the industry procedure. Once you start working at a medical practice, you’ll see that it’s possible for this process to run smoothly and predictably. Part of your job will be to ensure that.

Here is an overview of the steps involved in processing each medical claim:

1. Check in the patient
When a patient arrives for an appointment, you should confirm the patient’s demographic information and confirm his or her insurance information (payer and policy number). Any of this can be useful with regards to a future claim.

2. Verify insurance and confirm eligibility
It’s important to verify the insurance for all patients, as well as their eligibility, before they receive medical care. People may not recall that their insurance coverage has changed, or the payer may have changed the terms of their coverage without the patient’s knowledge. It is your responsibility to discover this information.

3. Code any procedures and diagnoses
In order to inform the insurance payer of any treatment the patient may be receiving, as well as the method(s) of that treatment, it’s essential that you code the claims accurately. This is something you will become more familiar with over time.

4. Enter the charges
Called the “charge entry,” this refers to the amount that is due for services the patient received. This item is in the patient’s file and should also include any relevant medical codes, so that the services and procedures the patient received are clear to anyone looking at the record.

5. Submit the claim
Once you have completed processing the claim, you will submit it to the appropriate insurance payer for payment. While there are a standard set of guidelines for the billing process, there are many variables that are unique to each particular insurer. Over time you will get to know these, but it requires good organization to stay on top of them.

6. Post payments
This is the final step in the claim submission process, and involves making sure that the payment has been received and deposited into your employer’s account. If the patient’s insurance covers his or her procedure/visit in full, then once you receive payment from the insurer, the amount you need to bill the patient for will be zero. It will be your responsibility to follow up with the patient about any unmet portion of the billing.

If you learn to follow these six steps, you will find that in many cases the medical billing process can be smooth and efficient. We hope you have been inspired to learn more about medical billing and coding programs like the one we offer at the Salter School. If you’re curious whether this might be a good career path for you, read more about the traits that most claims specialists have. We wish you the best of luck, no matter what you decide!



This article is part of the weekly blog of the Salter School. We offer several different professional training programs at our campuses in Malden and Fall River, MA. Reach out to us today for more information or to schedule a campus tour!

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