7.1 The Importance of Billing and Claims Processing
What exactly is ‘Billing & Claims Processing’? Practice Perfect’s definition of billing & claims processing, simply put, is taking the list of services and products that a client has accumulated for any amount of time (a day, a week, a month) and printing them to paper or preparing an electronic file in formats for which payment can be received. This is also referred to as invoicing. Both the term Billed and Invoiced appear in this chapter – they are interchangeable.
Imagine a credit card statement. You make purchases all month long. At the end of the month, all of those purchases appear on your statement. They don’t reappear the following month, they only appear once. You pay from this statement. While you don’t typically pay before you receive your statement, you can if you wish. Practice Perfect’s invoicing & claims processing works in exactly the same way with the exception that a bill/claim can be generated for any time period – you don’t have to wait an entire month.
Billing & claims processing is also the process that triggers your Accounts Receivable to ‘start counting’. Practice Perfect does not start the clock running, or ‘Aging’ Accounts Receivable until a bill/claim has been issued. Insurers cannot start to be held accountable for an account until they have received the list of services performed. The account can only start to ‘age’ once the payor has seen what they owe.
This section describes not only how to produce bills and claims for either one or a group of people, but also how to reprint bills & claims, reassign balances of unpaid services to a different payor and look up what was on a bill/claim as well.
Related topics include the entry of Treatments and Services, discussed in Chapter 6, receiving payments, discussed in Chapter 8 and managing your Account Receivable, discussed in Chapter 10.