10 Simple way in the Medical Billing Process
Medical billing is the process of collecting payment for healthcare services. It connects patients, providers (like doctors or clinics), and insurance companies. Whether you run a clinic or just want to understand how bills are handled after a doctor’s visit, here are the 10 basic steps of the Medical billing workflow explained in simple words.
1. Patient Registration
This is the first step when a patient visits a clinic or hospital. Basic information is collected:
- Name
- Date of birth
- Insurance details
- Contact info
This ensures the clinic knows how to bill the right insurance company and how to contact the patient if needed.
2. Insurance Verification
Before treatment begins, the staff checks whether the patient’s insurance is active and what services it covers. This step helps avoid surprises later — like denied claims or unpaid bills.
3. Patient Check-in and Appointment
When the patient arrives for their appointment, they may be asked to:
- Confirm their personal details
- Pay a co-pay (a small part of the cost the patient pays upfront)
- Sign forms
This keeps records up to date and helps with smooth billing later.
4. Medical Coding
After the patient sees the doctor, the healthcare provider documents what happened during the visit. Then, professional coders turn these services into standard codes:
- CPT codes for procedures
- ICD codes for diagnoses
These codes are essential for billing the insurance company.
5. Charge Entry
Now the codes and costs are entered into a billing system. Each code is matched with a price. This step creates a bill (also called a "claim") to be sent to the insurance company.
6. Claim Submission
The claim is submitted electronically to the patient’s insurance company. This claim includes:
- Patient and provider info
- Diagnoses and treatment codes
- Total charges This is where the actual billing process begins.
7. Insurance Claim Processing
The insurance company reviews the claim and decides:
- How much to pay the provider
- How much the patient owes
If something is missing or incorrect, the claim may be denied or rejected, which means it needs correction and resubmission.
8. Payment Posting
Once the insurance pays its portion, the payment is posted in the clinic’s system. If part of the bill is unpaid (like a deductible or co-insurance), the clinic sends that balance to the patient.
9. Patient Billing
Now the patient receives a bill for the remaining amount. It may include:
- Explanation of what the insurance covered
- How much the patient needs to pay
Patients can pay through various methods — online, in person, or by mail.
10. Follow-up and Collections
Sometimes, patients don’t pay their bills on time. In that case, the billing team:
- Sends reminders
- Offers payment plans
- Sends the account to collections if unpaid for too long
Follow-up is important to make sure the clinic gets paid for services provided.
Final Thoughts
The medical billing process may seem complex, but breaking it into 10 steps makes it easier to understand. Each step plays a role in ensuring healthcare providers are fairly paid and patients are billed correctly.
Whether you're running a small clinic or just curious, knowing these steps helps you manage healthcare costs and avoid billing surprises.
