Before a provider can file a claim for
their encounter with the patient, there are certain authorizations that must be
obtained and information collected:
Provider (physician) must be credentialed with insurance payers.
Provider must be enrolled with insurance companies to send claims electronically.
Patient personal information collected.
Patient insurance information collected.
Patient authorization for provider to submit claims on their behalf.
Practice Management Software
Just about every healthcare provider uses
a practice management software to manage their practice. There are hundreds
available. Practice management and medical billing software are used
interchangeably. Just about all of them can perform the same basic functions:
Scheduling patient visits
Managing patient accounts
Creating insurance claims
Recording insurance and patient payments
Creating patient statements
Tracking claim status
Provider info Entered in Practice Management Software
CMS-1500 Claim Form
The most important form in medical
billing in both its paper and electronic form.
Contains all the information from the
patient encounter in one form.
The CMS-1500 form was developed by the
National Uniform Claim Committee (NUCC).
NUCC is responsible for standardizing
instructions for completion of the form.
Patient Information Form
Patient Insurance Card
Patient Insurance Info Entered in Practice Management Software
Patient Encounter Code Entry in Practice Management Software
Other Important Forms
following forms are required on the first patient visit to obtain all the
necessary information and authorization to bill for the visit:
Information which includes Insurance, Guarantor, Assignment of Benefits,
for Release of Medical Information
Word templates of these and many other forms are included with the Fundamentals