medical billing

1. HIPPA COMPLIANCE ACT of 1996
* What is HIPAA act of 1996: HIPAA stands for - Health insurance portability and accountability act of 1996.
* The HIPAA act of 1996 is federal law that required the creation on national standards to protect sensitive
PATIENT HEALTH INFORMATION (PHI) from being disclosed without the patients consent or acknowledgement.
* The US department of health & human services (HHS) issued the HIPAA privacy rules to implement the
requirements of HIPAA.
* All the 3 'P' entities i.e., Patient, Provider, Payer, Clearing Houses (Trizetto, Office Ally etc), billing companies and
other associated business entities are bind to follow HIPAA rules.
* PHI includes following info should not be disclosed or shared to anyone without patients consent:
Patient demographics such as Name, DOB, SSN, Address, Phone#, Medical History etc.,
* Each employee/Trainee is trained on policies & procedures on HIPAA before getting login. HIPAA violations could
lead to practice penalties & even prison on some cases.
* We should use HIPAA certified emails only; ex: MD Office mail email support
* Communication System such as Microsoft Teams, Wasp and Google Talk ete.
* No Hard copies of paper at office work place;
* Mobile phones, Memory card and other data transfer system.

2. REVENUE CYCLE MANAGEMENT & ITS KEY COMPONENTS
Revenue Cycle Management (RCM) in the US healthcare industry refers to the process of managing the financial
transactions and interactions between healthcare providers and patients throughout the entire patient care
journey, from appointment scheduling to the final payment of services rendered. The primary goal of RCM is to
optimize the revenue generated by healthcare services while ensuring accuracy, efficiency, and compliance with
regulatory requirements.
Efficient revenue cycle management is essential for healthcare organizations to maintain financial stability,
minimize revenue leakage, and ensure timely reimbursement for services provided. With the complexity of
healthcare billing and reimbursement processes, effective RCM practices can help improve cash flow, reduce
administrative costs, and enhance overall operational efficiency in the healthcare industry.
RCM process which includes 14 key components mentioned as below flow chart.

4. PATIENT REGISTRATION PROCESS
Patient registration is the process of collecting patient demographic and insurance information, verifying
insurance coverage, and creating a patient account in billing software/practice management system (software). It
is an important aspect of revenue cycle management (RCM) as it sets the foundation for accurate billing and claims
submission as the patient registration process plays a key role in RCM process.
Following is the info to be collected and validated from patient:
1. Patient Demographics: Collecting patient demographic information such as name, address, phone
number, date of birth, and emergency contact information and also creating a patient account by entering
the collected information into the practice management system, such as electronic health records (EHR)
or billing software. We need to validate the patient demographics and insurance info if the patient is an
established patient.
2. Payer Information & Validation: Collecting insurance information such as the name of the insurance
carrier, policy number, group number, and Subscriber/policy holder info. In case the patient is an
established patient, we need to verify whether we have the entire patient's demographic information,
guarantor information, and insurance information accurately recorded. If any information is found to be
incorrect, inappropriate, or insufficient, we should obtain the necessary details from the patient and
request them to bring related documents, such as a driver's license or an updated insurance card copy, to
the office at the time of their visit.
3. Provider Information: Referring provider name and rendering provider name, NPI, etc.
4. Service-Related: Confirmation of order on file, order validation (dated, signed, etc.), service and service
location selected in the system for walks-ins or validation for scheduled patients, may include bed
selection and assignment (varies by provider site), etc.
5. Payment Related: Patient liability estimates such as Co-Pays, Self pay rates if the patient is uninsured,
requesting, collecting, receipting, and securing patient liability payments if patient is established patient.
6. Compliance Related: Processing of general patient consent forms and notices for provider, local, state,
and federal regulators and other provider-specific forms that ensure provider and patient protection (may
include Medicare ABN (Advanced beneficiary Notice), MOON (Medicare Outpatient Observation Notice),
and related forms), etc.
Sample Video reference: https://www.youtube.com/watch?v=4q0ZuZ8Q1SY

5. APPOINTMENT SCHEDULING PROCESS
Visiting a physician and not finding him there or waiting for too long to see the physician are things that
frustrate a patient. While not showing up for visit or arriving late for a scheduled check-up is things that
do not go well for practice or physician. So, in order to avoid any such situations, it’s better to schedule
an appointment at the medical office as it saves time for both the patient and practitioner. Appointment
scheduling determines which patients will see the physician, the date and time of their appointment,
and the duration of the appointment set by the medical assistant.
Fixing or scheduling an appointment depends on various factors like patient needs, physician
preferences, available facilities, and the duration of the visit. Patient needs involve the patient’s
availability for visit, the urgency of his visit, or the purpose of the visit. Physician preferences involve
time each physician gives to a patient, breaks he takes between visits or other tasks he needs to take
care of. Available facilities for a procedure or the purpose and duration for which a patient needs to visit
a medical office like a check-up, examination, or minor surgery also determine the type of appointment
scheduling. The most common type of appointment scheduling in a medical office are:
1) Open office hours – This type of scheduling involves no fixed or previous bookings and the office
keeps itself open during the working hours. Patients are seen by the physician in the order of
their arrival. In this method, the physician doesn’t have to worry about a patient breaking an
appointment or the office running behind schedule. It is mostly followed by urgent care clinics
and emergency rooms. The main disadvantage of this system is that it increases the wait times
for patients and keeps the physician extremely busy for a part of the day.
2) Scheduled or fixed appointments – This is a more planned and easiest method of patient
scheduling without keeping the wait time high for patients. It aligns the patient visits depending
on the number of patients arriving and the average time required for each patient. It also keeps
breaks for the physician and keeps him less burdened.
3) Flexible Office Hours – This type of scheduling is done for patients who could not visit the office
during normal working hours. Evening and weekend hours are generally kept free for such
patients.
4) Wave Scheduling – This type of scheduling involves giving the same slot within an hour to 3-4
patients and the one arriving first sees the doctor first. It saves time of practitioner as if one
patient runs late the other is there and can be seen. In some cases, it might increase the wait
time for patients if all of them arrive on time.
5) Advanced Scheduling – This type of scheduling involves booking appointments day or month in
advance. It is often done for regular health checkups or surgical procedures. Advanced
scheduling requires medical office staff to call and remind the patients about their
appointments a few days or hours before their slot. It also requires 24 hours’ notice to cancel
any appointment.
6) Rescheduling Canceled Appointments – It is done for patients who had missed their
appointment or had to cancel them due to any reasons. They are generally accommodated in
canceled slots or taken up before a new appointment is made.

6. 7) Emergency Appointments – These are arranged for patients who need to see the physician
urgently. They are generally made on request subject to availability of the physician and
depending on the signs and symptoms that constitute an emergency situation.
Importance of patient scheduling process:
Patient scheduling is a vital process in the healthcare industry that enables medical practices and clinics
to efficiently manage patient appointments. It involves the use of a scheduling system to book and
manage appointments for patients, including initial consultations, follow-up visits, and medical
procedures.
Efficient patient scheduling helps healthcare providers to optimize their resources, reduce wait times,
and enhance the overall patient experience. It also plays a critical role in ensuring that patients receive
timely and appropriate medical care, which is essential for their well-being.
In a healthcare setting, patient scheduling can be a complex task, as it requires balancing the availability
of healthcare providers and facilities with the needs and preferences of patients. A scheduling system
that is easy to use and allows patients to book and manage appointments conveniently can help
healthcare providers improve patient satisfaction and loyalty. Moreover, patient scheduling systems can
enable healthcare providers to streamline administrative tasks, such as appointment reminders and
confirmations, which can improve patient adherence to appointments and reduce no-shows.
Patient scheduling is a crucial aspect of healthcare operations for several reasons:
1) Timely and appropriate care: Patient scheduling ensures that patients receive timely and
appropriate medical care, which is essential for their health and well-being. A delay in receiving
medical attention can exacerbate health conditions, leading to more severe health outcomes.
Efficient patient scheduling ensures that patients receive care when they need it, reducing the
risk of complications and improving health outcomes.
2) Resource optimization: Patient scheduling helps healthcare providers optimize their resources,
including the availability of healthcare providers and facilities. By scheduling appointments
efficiently, providers can reduce wait times and ensure that resources are used effectively,
improving the quality of care.
3) Patient satisfaction: Efficient patient scheduling helps improve the patient experience, which is
critical for patient satisfaction and loyalty. A scheduling system that is easy to use and allows
patients to book and manage appointments conveniently can help improve patient satisfaction
and loyalty.
4) Administrative efficiency: Patient scheduling systems can help healthcare providers streamline
administrative tasks, such as appointment reminders and confirmations, which can improve

7. patient adherence to appointments and reduce no-shows. Additionally, scheduling systems can
help providers manage patient wait times, which is a critical factor in patient satisfaction and
experience.
Sample Video reference: https://www.youtube.com/watch?v=83CfKKo6N4Y
–––––––––––––––––––––––––––Sample patient registration form attached to the next page

8. PATIENT REGISTRATION FORM
Welcome to our practice. As a new patient, please complete the following information to the best of your ability.
Patient Information:
Last Name First Name Middle Initial
Street Address City/State/Zip Code Social Security #
Phone Number/Other Date of Birth Male or Female
Cell Phone Email Marital Status S / M / D / W
Emergency Contact/Phone # Pharmacy Name & Phone #
Employer Information:
Name Work Number Occupation
Address City/State/Zip Code
Referred By: (From whom did you hear about the Doctor? Self referred or from another Doctor?)
Referred By: Address Phone #
Primary Care Physician: Address Phone#
Insurance Information:
Name of First Insurance Company
Street Address City State Zip Code
Insurance ID Number Local/Group Number
Name of Secondary Insurance Company
Street Address City State Zip Code
Insurance ID Number Local/Group Number
Subscriber Information: (Policyholder if different from patient)
Relationship to Patient Name Date of Birth
Social Security Address Zip Code
Home Number Employer’s Name Work Number
I request that payment under the medical insurance program be made directly to the provider of service on any unpaid bill
for services provided. I further authorize any holder of medical or other information about me to release the Social Security
Administration, its carriers of insurance Companies, any information needed for this or related Medicare or insurance claim.
I permit a copy of this authorization to be used in place of the original. Information needed for this or a related Medicare or
insurance claim. Permit a copy of this authorization to be used in place of the original.
Signature of Patient or Authorized Representative: Date:
DIVISION OF HEMATOLOGY/ONCOLOGY

9. Date:
Patient Name Date of Birth Sex: F or M
Height: Weight:
Diagnosis:
Location:
(Where is the pain/problem?)
Severity:
(How severe is the pain/problem on a scale of 1-5 with 5 being
the most severe?)
Associated signs/symptoms:
Past Medical History
Have you ever had the following: (Circle “no” or “yes”, leave blank if uncertain)
Previous Hospitalizations/Surgeries/Serious Illnesses When? Hospital, City, State
_______________________________________________ ______________ ________________________________
_______________________________________________ ______________ ________________________________
_______________________________________________ ______________ ________________________________
Medications: (Include dose & frequency, over the counter medications and/or supplements)
Patient social history:
Marital status: Single:_______ Married: ________ Separated:________ Divorced:________ Widowed: ________
Use of alcohol: Never: _______ Rarely: _________ Moderate: ________ Daily:___________
Use of tobacco: Never: _______ Previously, but quit: ________________ Current packs / day: __________________
Use of recreational drugs: Never: _______ Type/Frequency: _________________________ ____________________________
Excessive exposure Airborne
At home or work to: Fumes:_______ Dust: ___________ Solvents:_________ Particles: ________ Radiation ________
Family medical history:
Age Disease/Diagnosis If Deceased, cause of Death & When
Father ________ ___________________________________________ ___________________________________________________
Mother ________ ___________________________________________ ___________________________________________________
Siblings ________ ___________________________________________ ___________________________________________________
________ ___________________________________________ ___________________________________________________
________ ___________________________________________ ___________________________________________________
Spouse ________ ___________________________________________ ___________________________________________________
Children ________ ___________________________________________ ___________________________________________________
________ ___________________________________________ ___________________________________________________
________ ___________________________________________ ___________________________________________________
AIDS or HIV+................... no yes
Anemia.............................. no yes
Arthritis............................. no yes
Asthma.............................. no yes
Back trouble...................... no yes
Bladder infections............. no yes
Bleeding Tendency............ no yes
Blood or Plasma
Transfusions...................... no yes
Bronchitis.......................... no yes
Cancer ............................... no yes
Chickenpox ....................... no yes
Date of last chest x-ray ____________
Diabetes............................. no yes
Diphtheria ......................... no yes
Epilepsy............................. no yes
Glaucoma.......................... no yes
Heart Disease.................... no yes
Hemorrhoids ..................... no yes
Hepatitis............................ no yes
Hernia................................ no yes
High Blood Pressure ......... no yes
Hives or Eczema ............... no yes
Infectious Mono................ no yes
Kidney Disease ................. no yes
Liver Disease..................... no yes
Low Blood Pressure.......... no yes
Measles ............................. no yes
Migraine Headaches ......... no yes
Mitral Valve Prolapse........ no yes
Mumps .............................. no yes
Phneumatic Fever.............. no yes
Pneumonia......................... no yes
Polio .................................. no yes
Scarlet Fever...................... no yes
Shingles............................. no yes
Smallpox ........................... no yes
Stroke................................ no yes
Thyroid Disease ................ no yes
Tuberculosis ...................... no yes
Ulcer.................................. no yes
Venereal Disease............... no yes
Whooping Cough.............. no yes
Any other disease.............. no yes
(please list): ____________________
_______________________________
_______________________________
Duration:
(How long have you had this pain/problem?
Occurrence:
(Does the pain/problem occur at a specific time?)
(What other associated problems have you been having?)
DIVISION OF HEMATOLOGY/ONCOLOGY
HEALTH HISTORY

10. † Constitutional Symptoms
Good general health lately............... No Yes
Recent weight change...................... No Yes
Fever................................................ No Yes
Fatigue............................................. No Yes
Headaches ....................................... No Yes
Night Sweats ................................... No Yes
† Eyes
Eye disease or injury....................... No Yes
Wear glasses/contact lenses............. No Yes
Blurred or double vision.................. No Yes
Cataracts.......................................... No Yes
† Ears/Nose/Mouth/Throat
Hearing loss or ringing.................... No Yes
Earaches or drainage ....................... No Yes
Chronic sinus problem or rhinitis.....No Yes
Nose bleeds ..................................... No Yes
Mouth sores..................................... No Yes
Bleeding gums................................. No Yes
Bad breath or bad taste.................... No Yes
Sore throat or voice change............. No Yes
Swollen glands in neck.................... No Yes
† Cardiovascular
Heart trouble.................................... No Yes
Chest pain or angina pectoris.......... No Yes
Palpitation ....................................... No Yes
Shortness of breath w/walking
or lying flat ...................................... No Yes
Swelling of feet, ankles or hands .... No Yes
† Respiratory
Chronic or frequent coughs............. No Yes
Spitting up blood............................. No Yes
Shortness of breath.......................... No Yes
Wheezing......................................... No Yes
Emphysema..................................... No Yes
† Gastrointestinal
Heartburn ........................................No Yes
Loss of appetite ............................... No Yes
Change in bowel movements........... No Yes
Nausea or vomiting ......................... No Yes
Frequent diarrhea ............................ No Yes
Painful bowel movements
or constipation................................. No Yes
Rectal bleeding or blood in stool..... No Yes
Abdominal pain............................... No Yes
† Genitourinary
Frequent urination ........................... No Yes
Burning or painful urination ........... No Yes
Blood in urine.................................. No Yes
Change in force of strain
when urinating................................. No Yes
Incontinence or dribbling ................ No Yes
Kidney stones.................................. No Yes
Sexual difficulty .............................. No Yes
Male-testicle pain............................ No Yes
Female-pain with periods................ No Yes
Female-irregular periods ................. No Yes
Female-vaginal discharge................No Yes
Female - abnormal bleeding............No Yes
Female - date of last period....... __________
Female-# of pregnancies ........... __________
Female-# of miscarriages .......... __________
Female- date of last pap smear.. __________
(If yes, when)............................. __________
† Musculoskeletal
Joint pain......................................... No Yes
Joint stiffness or swelling................ No Yes
Weakness of muscles or joints......... No Yes
Muscle pain or cramps .................... No Yes
Back pain......................................... No Yes
Cold extremities .............................. No Yes
Difficulty in walking ....................... No Yes
† Integumentary (skin, breast)
Rash or itching ................................ No Yes
Change in skin color........................ No Yes
Change in hair or nails .................... No Yes
Varicose veins.................................. No Yes
Breast pain....................................... No Yes
Breast lump ..................................... No Yes
Breast discharge .............................. No Yes
† Neurological
Frequent or recurring headaches..... No Yes
Light headed or dizzy...................... No Yes
Convulsions or seizures................... No Yes
Numbness or tingling sensations..... No Yes
Tremors ........................................... No Yes
Paralysis .......................................... No Yes
Head injury...................................... No Yes
† Psychiatric
Memory loss or confusion............... No Yes
Nervousness .................................... No Yes
Depression....................................... No Yes
Insomnia.......................................... No Yes
† Endocrine
Glandular or hormone problem....... No Yes
Excessive thirst or urination............ No Yes
Heat or cold intolerance .................. No Yes
Skin becoming dryer ....................... No Yes
Change in hat or glove size ............. No Yes
† Hematologic/Lymphatic
Slow to heal after cuts ..................... No Yes
Bleeding or bruising tendency ........ No Yes
Anemia............................................ No Yes
Phlebitis/Blood clots ....................... No Yes
Past transfusion ............................... No Yes
Enlarged glands............................... No Yes
Date of last transfusion........ _____________
† Allergic/Immunologic
History of skin reaction or other adverse
reaction to:
Penicillin or other antibiotics ........ No Yes
Morphine, Demerol,
or other narcotics........................... No Yes
Novocaine or other anesthetics ..... No Yes
Aspirin or other pain remedies...... No Yes
Tetanus antitoxin
or other serums.............................. No Yes
Iodine, Merthiolate or
other antiseptic.............................. No Yes
Other: _____________________________
____________________________________
Known food allergies: __________________
____________________________________
Environmental allergies: ________________
____________________________________
† Other Symptoms
____________________________________
____________________________________
____________________________________
Review of Systems: Please indicate any personal history below:
To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect
information can be dangerous to my health. It is my responsibility to inform the doctor’s office of any changes in my medical status.
I also authorize the healthcare staff to perform the necessary services I may need.
Signature of Patient, Parent or Guardian Date
Signature of Doctor Date
Patient Name ____________________________________________
Date of Birth ____________________
DIVISION OF HEMATOLOGY/ONCOLOGY