Present Cost Estimates and Payment Options to Patient
8
Approval: Cost Estimate
9
Apply Insurance Benefits to Hospital Bill
10
Generate Final Hospital Bill
11
Send Bill to Patient
12
Receive Payment from Patient
13
Post Payment to Patient Account
14
Alert Collections for Unpaid Bills
15
Audit Patient's Financial Account
16
Approval: Final Audit of Patient's Account
17
Update Patient's Financial Account
18
Send Payment Receipt to Patient
19
Close Out Patient's Financial Account
Patient Check-In and Information Collection
Welcome the patient to the hospital and gather all necessary information for their registration. Ensure a smooth check-in process while maintaining patient comfort and privacy. Validate the accuracy and completeness of the collected information. Set the foundation for the patient's entire hospital bill administration process.
1
Male
2
Female
3
Other
1
Provider A
2
Provider B
3
Provider C
4
Provider D
5
Provider E
Verification of Insurance Details
Confirm the patient's insurance coverage and policy details. Determine if the insurance provider is in-network or out-of-network. Gather all pertinent information necessary to process insurance claims accurately and efficiently. Ensure a seamless transition to the next step of the hospital bill administration process.
Obtain Pre-Authorization from Insurance Company
Initiate the pre-authorization process with the patient's insurance company to ensure coverage for the upcoming medical procedures. Verify the necessary medical documentation and other requirements for authorization. Collaborate with the insurance representative to expedite the approval process. Smoothly proceed to the next stage of the hospital bill administration process.
1
MRI
2
CT Scan
3
Surgery
4
X-ray
5
Lab Tests
Triage and Diagnostic Procedures
Adhere to medical protocols and conduct the necessary triage and diagnostic procedures. Ensure the patient's well-being and accurate assessment of their medical condition. This task plays a vital role in determining the appropriate treatment plan and estimating the overall cost. Collaboration with the medical team should address any arising challenges to maintain a smooth hospital bill administration process.
1
Blood tests
2
Physical examination
3
Ultrasound
4
EKG
5
Endoscopy
Prepare Estimated Cost of Treatment
Calculate and provide an estimated cost of the patient's treatment based on the triage and diagnostic results. Take into account the required procedures, medical staff involvement, and any additional factors affecting the bill. Help the patient gain clarity about the financial aspect of their healthcare journey. Collaborate with the financial department or relevant personnel to ensure accurate estimations.
1
Medication
2
Physical Therapy
3
Surgery
4
Radiation Therapy
5
Chemotherapy
Identify any Deductibles or Co-pays
Explore potential deductibles and co-pays that the patient may be responsible for. Explain in detail the concept of deductibles and co-pays, ensuring the patient fully understands their obligations. Offering clarity regarding financial responsibilities enhances trust and cooperation throughout the hospital bill administration process.
1
0%
2
10%
3
20%
4
30%
5
40%
Present Cost Estimates and Payment Options to Patient
Present the patient with a comprehensive breakdown of the estimated cost, deductibles, and co-pays. Explain the various payment options available, such as payment plans, insurance coverage, or external financial assistance programs. Ensure the patient is fully informed to make an educated decision regarding their financial obligations related to their healthcare.
1
Full Payment
2
Installments
3
Insurance Coverage
4
Financial Assistance
Approval: Cost Estimate
Will be submitted for approval:
Prepare Estimated Cost of Treatment
Will be submitted
Identify any Deductibles or Co-pays
Will be submitted
Present Cost Estimates and Payment Options to Patient
Will be submitted
Apply Insurance Benefits to Hospital Bill
Initiate the insurance billing process by accurately applying the patient's insurance benefits to the overall hospital bill. Collaborate with the billing department or relevant personnel to ensure proper coding and documentation for reimbursement. Obtain any necessary approvals or signatures to proceed with the bill processing.
1
Inpatient services
2
Outpatient services
3
Medication coverage
4
Diagnostic tests
5
Emergency services
Generate Final Hospital Bill
Compile all relevant charges and expenses into the final hospital bill. Ensure accurate invoicing and inclusion of all billable items. Collaborate with the billing department or relevant personnel to verify the completeness and correctness of the generated bill. This task sets the stage for the subsequent steps in the hospital bill administration process.
1
Room charges
2
Procedure charges
3
Medication charges
4
Doctor fees
5
Additional charges
Send Bill to Patient
Send the final hospital bill to the patient for their review and payment. Ensure timely delivery and proper communication regarding the bill's contents and payment due date. Use an appropriate method of delivery, such as physical mail or secure electronic means. Properly addressing this task fosters transparency and mutual understanding throughout the hospital bill administration process.
Receive Payment from Patient
Receive payment from the patient for the hospital bill. Offer various payment methods to accommodate the patient's preferences and convenience. Ensure secure handling of payment information and prompt processing of the received payment. Efficiently tracking and managing the payment streamlines the hospital bill administration process.
1
Credit Card
2
Debit Card
3
Cash
4
Check
5
Online Payment
Post Payment to Patient Account
Accurately record and post the received payment to the patient's financial account. Maintain proper documentation of the payment transaction for future reference and auditing purposes. Collaborate with the accounting or financial department to ensure correct and secure posting of the payment.
Alert Collections for Unpaid Bills
In cases of unpaid bills, alert the collections department to initiate appropriate follow-up actions. Promptly notify the collections team regarding outstanding payments and provide the necessary details for further handling. Accurate and timely communication with the collections department contributes to efficient debt recovery and overall hospital bill administration.
Audit Patient's Financial Account
Perform a comprehensive audit of the patient's financial account to ensure accuracy and compliance with internal financial policies. Verify the integrity of financial records, payment postings, adjustments, and any outstanding balances. This task guarantees the reliability and credibility of the patient's financial account throughout the hospital bill administration process.
1
Internal Audit
2
External Audit
3
Ongoing Compliance Audit
Approval: Final Audit of Patient's Account
Will be submitted for approval:
Audit Patient's Financial Account
Will be submitted
Update Patient's Financial Account
Update the patient's financial account with any necessary adjustments, refunds, or corrections identified during the audit process. Collaborate with the accounting or financial department to ensure accurate and secure updates to the financial account. Maintain clear communication with the patient regarding any modifications made to their account.
1
Adjustment
2
Refund
3
Correction
Send Payment Receipt to Patient
Send the payment receipt to the patient, confirming the successful processing and posting of their payment. Clearly state the payment details, amount, date, and any applicable account adjustments. Demonstrate transparency and accountability in the financial aspect of the hospital bill administration process.
Close Out Patient's Financial Account
Complete the patient's financial account closure with proper documentation and financial reconciliation. Ensure all outstanding payments, adjustments, and refunds are accurately recorded and reflected in the final account statement. Collaborate with the financial department to finalize the account closure and maintain a comprehensive overview of the patient's entire financial journey.
