Approval: Patient's Medical History and Documents Verification
7
Provide Treatment Services
8
Document Services Provided
9
Prepare Billing Statement
10
Charge Capture
11
Charge Entry
12
Submit Bill to the Insurance Company
13
Approval: Billing Verification
14
Follow Up on Insurance Claim
15
Post Payment or Adjustment
16
Patient Statement Generation
17
Manage Unpaid Patient Payment
18
Approval: Final Account Settlement
19
Update Records with Payments Collected
20
Close Account
Patient Registration
Welcome the patient to our hospital and gather their personal information to update our records. This task is crucial in ensuring accurate and up-to-date patient data for better healthcare services. The desired outcome is a completed registration form and all relevant documents required for verification. Are there any challenges in gathering all the necessary information? Don't hesitate to ask the patient or consult the supervisor for guidance.
1
Male
2
Female
3
Other
Record Personal Information
Now that you have gathered the patient's personal information, it's time to record it accurately in our system. This task is vital for maintaining precision in medical records and ensuring seamless communication with the patient. Can you recall the details accurately or is there any information missing that needs verification?
Verification of Patient Insurance
Before providing any services, we need to verify the patient's insurance coverage to avoid any billing issues. This task ensures that we have accurate and up-to-date insurance information. Is the patient's insurance valid and active? If not, what steps should be taken?
1
Verified
2
Not Verified
Determine Patient Financial Responsibility
To provide the patient with the most suitable financial options, we need to determine their financial responsibility for the services provided. This task ensures transparency and assists in creating accurate billing statements. Is the patient responsible for the full payment or is there a third party involved?
1
Patient
2
Insurance
3
Third Party
Schedule Appointments
Booking appointments efficiently is crucial for both the hospital and patients. This task involves coordinating with the patient and allocating the appropriate time slots. Do we have available time slots that align with the patient's preferences? Is there any special equipment or personnel required for the appointment?
1
Morning
2
Afternoon
3
Evening
Approval: Patient's Medical History and Documents Verification
Will be submitted for approval:
Record Personal Information
Will be submitted
Provide Treatment Services
Delivering the necessary treatment services to patients is the core of our hospital's mission. This task involves providing quality healthcare services while maintaining patient comfort and safety. What services are required? Have any medical conditions been identified that should be considered during treatment?
1
Surgery
2
Medication
3
Physical Therapy
4
Radiology
5
Lab Tests
Document Services Provided
Accurate documentation of the services provided is vital for billing and maintaining the patient's medical history. This task ensures proper record-keeping and supports efficient reimbursement processes. What specific details should be documented? Are there any additional documents, such as lab reports or imaging results, that need to be attached?
Prepare Billing Statement
Creating an accurate and clear billing statement is essential for transparent communication with the patient and prompt payment collection. This task involves itemizing the services provided and calculating the financial responsibility. Are all the services listed correctly? Is the insurance information accurately reflected?
Charge Capture
Capturing all the charges associated with the services provided ensures accurate financial records and smooth billing processes. This task involves identifying and recording all relevant charges for a patient's visit. Are there any charges that might be missed or require clarification? Are there any discounts or additional charges to be considered?
1
Lab Services
2
Medication
3
Surgery
4
Radiology
5
Consultation
Charge Entry
Accurate charge entry is crucial for maintaining financial records and generating correct billing statements. This task ensures that all charges are properly entered into the billing system. Is the charge entry process clear, or are there any complexities to consider? Are there multiple service providers involved?
Submit Bill to the Insurance Company
Submitting bills to the insurance company is an essential step in the revenue cycle process. This task ensures timely submission for maximum reimbursement. Is there any specific protocol or format to follow when submitting bills to the insurance company? Are there any supporting documents required?
Approval: Billing Verification
Will be submitted for approval:
Prepare Billing Statement
Will be submitted
Charge Capture
Will be submitted
Charge Entry
Will be submitted
Submit Bill to the Insurance Company
Will be submitted
Follow Up on Insurance Claim
Monitoring the progress of insurance claims is crucial for timely payment collection. This task involves proactively following up with the insurance company to ensure prompt resolution. Is there a specific timeframe for following up? Are there any additional actions required during the follow-up process?
Post Payment or Adjustment
Once the insurance company provides payment or adjustment, it's important to accurately post it in the patient's financial records. This task ensures uncomplicated reconciliation and prevents discrepancies. Are there any specific codes or references to include when posting payment or adjustment? Is there a need to inform the patient about the outcome?
1
Payment
2
Denial
3
Partial Payment
4
Credit Adjustment
5
Discount
Patient Statement Generation
Generating patient statements promptly facilitates effective communication and accelerates payment collection. This task involves creating clear and comprehensive patient statements. Are all the service details accurate? Is the payment information clearly presented?
1
Credit Card
2
Check
3
Cash
4
Online Payment
5
Payment Plan
Manage Unpaid Patient Payment
Monitoring and managing unpaid patient payments promptly ensures financial stability for the hospital. This task involves regular follow-up and providing suitable options for payment resolution. Are there any specific payment reminder intervals to follow? Is there a defined procedure for payment negotiation or adjustments?
Approval: Final Account Settlement
Will be submitted for approval:
Manage Unpaid Patient Payment
Will be submitted
Update Records with Payments Collected
Accurate record-keeping of collected payments is vital for financial reporting. This task involves updating the patient's financial records with the payments received. Are there any specific codes or references to include when updating the records? Should a receipt be issued to the patient?
Close Account
Closing the patient's account marks the completion of the revenue cycle process for that episode of service. This task involves reviewing all financial records for accuracy and archiving them appropriately. Is there a defined timeline for closing accounts? Are all billing and payment details reconciled?
