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Medical Billing Flow Chart
Revenue Cycle Management System
EligibilityPatients coverage isverified prior to visit
CodingMedical Records arereviewed and coded by Certified
Coders
Demographic & Charge EntryBilling specialists enterpatient
demographics and charges into the PMS
Transmission and PostingClaims are sent to the clearinghouse and
payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate
analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures
aretaken (Resubmission)
Doc usTMAbout people, process and technology
Hospital/Docsoffice
generatesSuper bills
Hospital/Docsoffice
generatesSuper bills
Insurance CompanyReleasingpayments
Insurance CompanyReleasingpayments
Clearing Houses For
Electronic Clearance
Clearing Houses For
Electronic Clearance
Demo EntriesCharge entriesMedical CodingEOBsPayment
PostingsDenialsClaims SubmissionA/R AnalysisFollow upsInsurance
CallingPatients StatementPatient CallingCustomer Care
Demo EntriesCharge entriesMedical CodingEOBsPayment
PostingsDenialsClaims SubmissionA/R AnalysisFollow upsInsurance
CallingPatients StatementPatient CallingCustomer Care
Claims
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
REPORTS TO CLIENT
QUALITY AUDIT
GENERATION OF REPORTS
ACTION ON DENIALS / REJECTIONS
TRANSMISSION OF CLAIMS THRU CLEARING HOUSES
CASH APPLICATION AR ANALYSIS / CALLING
CASH TALLYING
CLIENT IN US SCANNING TO INDIA
CODING
Paid Claims for cash application
Unpaid ClaimsFor corrective action
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
Mail to India on Scan date, File name and directory path.
US Office scans Patient Demographics, Charge Sheets, Insurance
Card Copies,
etc.
Scanned copies would be saved as *.TIF (Tagged Image Format)
file and placed in
FTP Site
In the FTP Site, Files would be placed in the common path which
can be accessible by
India
Scanning Documents to IndiaScanning Documents to India Medical
CodingMedical Coding
Log to be maintained with File name, Total charges, Specialty
details, etc before Coding.
Coding of Diagnosis to the utmost specificity using ICD-9 CM
Manual.
Coding of Procedures by referring toCPT / HCPCS.
After Coding, files to be handed over to Charges Department for
processing.
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work
Ph, Guarantor, Marital Status, Subscriber details, Doctor#,
Insurance information etc to be entered in the system
After entering, printouts to be taken and data to be checked
Log to be maintained with Total Patients, Patients entered,
Pending details, etc.
Patient Account Numbering to be done, if system does not
generate automatically
Documents to be sorted Patient wise before entering into the
system
If any clarification is required, send mail to US office
Demographics entry
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
Charge Charge Entry
Patient Demographics and Coding to be done before entering
Charges
Charge File to be sorted by Patient / Date of Service
Patient #, Doctor # , Place of Service, Type of Service, Date of
Service, Procedure Code, Diagnosis Code, Modifier, Units, Value,
Referral , Prior Authorization, On Bill comments, etc. to beentered
in the system
After entering data, file to be given to Quality Audit for
checking
After checking and corrections, Claims to be transmitted.
After Transmission, Charges completion details to be sent to US
office.
If any clarification required, send mail to US office.
If any incorrect details found, Charges department to be
informed
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
Quality Audit for Patient Demographics and Charges before
sending batch wise update to client
After Quality Audit, files to be given to Supervisor / Manager
for sending Batch Update to client.
If any incorrect details found, Charges Team to be informed of
the same and correction done
Date of Service, Procedure Code, Diagnosis Code, Modifier,
Units, Value, Place of Service, Type of Service, Referral, Prior
Authorization, On bill comments, Location, etc to be checked in
Charges File
Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor,
Subscriber details, Employer, etc to be checked in Patient
Demographic File
Log to be updated with patients checked, charges checked,
correction details, etc
Quality Check
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
After Quality Check is through, List of Electronic Claims to be
separated
Transmission processes to be accurately followed to avoid
rejection
Claims to be transmitted electronically through different
clearing houses
After transmission, log to be updated with patient #, claim#,
total claims transmitted, pending claims, etc.
Send mail to Charges department after completion of
Transmission
If any incorrect details found, Charges department to be
informed
Claim TransmissionElectronic/Paper
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Medical Billing Flow Chart
Revenue Cycle Management System
Doc usTMAbout people, process and technology
If any incorrect details found or any details missing, follow up
to be done with Insurance
Log to be updated with Total Checks, Total Value, Posted
details, Pending details, etc
After Cash Posting, Claim#, Patient Name and Value to be checked
for tallying data with the EOB
Application of Payment, Deductible, Co-insurance, Adjustments,
Write offs, etc in the Cash Posting
In the EOB Copy, Claim#, Date of Service, Procedure , Units,
Charges to be identified before posting
Insurance Name, Check #, Total Check Value to be cross verified
with the Check and EOB Copies
Checks and EOB(Explanation of Benefits) to be arranged before
doing Cash Posting
Cash Posting
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