The document outlines the medical billing flow chart and revenue cycle management system. It involves verifying patient eligibility, coding medical records, entering demographic and charge data, transmitting claims to clearinghouses, receiving explanations of benefits (EOBs), posting payments, and following up on denials to increase collections. Key steps include eligibility checks, coding, data entry, quality audits, transmission, cash posting, and accounts receivable management.

1. Medical Billing Flow Chart
Revenue Cycle Management System
Eligibility
Patient’s coverage is
verified prior to visit
Clearing Houses
Clearing Houses
Coding For
For
Medical Records are
reviewed and coded by
Electronic Clearance
Electronic Clearance
Certified Coders
•Demo Entries
•Demo Entries
Hospital Insurance
Insurance
Demographic & Charge Entry Hospital •Charge entries
/Doc’s •Charge entries Company
Billing specialists enter /Doc’s •Medical Coding Company
patient demographics and office •Medical Coding Releasing
charges into the PMS office •EOB’s Releasing
generates •EOB’s Claims payments
generates •Payment Postings payments
Super bills •Payment Postings
Transmission and Posting Super bills •Denials
Claims are sent to the •Denials
clearinghouse and payments
•Claims Submission
•Claims Submission
(EOB) received are applied •A/R Analysis
•A/R Analysis
to the PMS •Follow up’s
•Follow up’s
•Insurance Calling
•Insurance Calling
Accounts Receivable •Patients Statement
Increase in collection ratio •Patients Statement
through accurate analysis •Patient Calling
•Patient Calling
and timely follow up •Customer Care
•Customer Care
Revenue Recovery
Old AR are analyzed and
corrective measures are
taken (Resubmission)
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2. Medical Billing Flow Chart
Revenue Cycle Management System
CLIENT IN US SCANNING TO INDIA
CODING
ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
QUALITY AUDIT
Paid Claims for Unpaid Claims
cash application TRANSMISSION OF CLAIMS THRU CLEARING HOUSES For corrective action
CASH APPLICATION AR ANALYSIS / CALLING
CASH TALLYING ACTION ON DENIALS / REJECTIONS
GENERATION OF REPORTS
REPORTS TO CLIENT
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3. Medical Billing Flow Chart
Revenue Cycle Management System
Scanning Documents to India Medical Coding
US Office scans Patient Demographics, Log to be maintained with File name, Total
Charge Sheets, Insurance Card Copies, charges, Specialty details, etc before
etc. Coding.
Scanned copies would be saved as *.TIF
(Tagged Image Format) file and placed in Coding of Diagnosis to the utmost
FTP Site specificity using ICD-9 CM Manual.
In the FTP Site, Files would be placed in the
common path which can be accessible by
India Coding of Procedures by referring to
CPT / HCPCS.
Mail to India on Scan date, File name and
directory path.
After Coding, files to be handed over to
Charges Department for processing.
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4. Medical Billing Flow Chart
Revenue Cycle Management System
Demographics entry
Documents to be sorted Patient wise before entering into
the system
Patient Account Numbering to be done, if system does not
generate automatically
If any clarification is required, send
Patient #, Name(LFM), Address, SSN, Sex, Employer, Home mail to US office
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.
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5. Medical Billing Flow Chart
Revenue Cycle Management System
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 If any clarification required, send
Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, mail to US office.
Referral , Prior Authorization, On Bill comments, etc. to be
entered 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 If any incorrect details found, Charges
office. department to be informed
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6. Medical Billing Flow Chart
Revenue Cycle Management System
Quality Check
Quality Audit for Patient Demographics and Charges before
sending batch wise update to client
Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph,
Guarantor, Subscriber details, Employer, etc to be checked
in Patient Demographic File
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
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
Log to be updated with patients checked, charges checked, the same and correction done
correction details, etc
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7. Medical Billing Flow Chart
Revenue Cycle Management System
Claim Transmission
Electronic/Paper
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
If any incorrect details found, Charges
#, claim#, total claims transmitted, pending
department to be informed
claims, etc.
Send mail to Charges department after
completion of Transmission
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8. Medical Billing Flow Chart
Revenue Cycle Management System
Cash Posting
Checks and EOB(Explanation of Benefits) to be
arranged before doing Cash Posting
Insurance Name, Check #, Total Check Value to
be cross verified with the Check and EOB
Copies
In the EOB Copy, Claim#, Date of Service,
Procedure , Units, Charges to be identified
before posting
Application of Payment, Deductible, Co-insurance,
Adjustments, Write offs, etc in the Cash Posting
If any incorrect details found or any details
After Cash Posting, Claim#, Patient Name and Value missing, follow up to be done with
to be checked for tallying data with the EOB Insurance
Log to be updated with Total Checks, Total
Value, Posted details, Pending details, etc
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