Medical Billing Process - Patient Bills Generation

Patient statment

Its been very long time since we are writing about Medical billing hereafter we will see at regular interval.

Bills are sent to the patient in two scenarios

--- When the patient is a self pay i.e. he has no insurance coverage

--- When the patient is responsible for co-insurance, if any, after the primary and the secondary, if any, makes payment.

In addition we may also bill patients in the following cases.

Insurance denies claims as:

· Coverage terminated

· Coverage not valid for DOS

· Benefits exhausted

· Procedure not covered

· Applied to deductible

· Unable to identify patient

· Requested information from patient not received by insurance

· Insurance information in demographics insufficient and no phone # available even through directory assistance for calling insurance.

It should be remembered that we should not bill MEDICAID patients unless they are denied for the reason coverage terminated or coverage not valid for DOS.

Patient bills show the amount due from the patient and the due date of payment.

The following are the contents of a patient bill:

Date of printing of bill

Patient’s/ Guarantor’s Name

Patient’s/ Guarantor’s Address

Patient Account #

Patient Balance

Address to which payment should be remitted

Date of service

Description of procedure performed

Name of attending doctor

Billed amount

Amount paid by Medicare/ other insurance

Amount paid by patient


Balance due

Due date of payment

In addition we now have the facility of printing the reason “why the patient was billed” in patient bills in addition to showing the insurance name.

Some billing companies have the facility to receive payments through credit cards in addition to cash and check.

Bills are sent to patients in cycles. A Bill Cycle denotes the number of times a bill is sent to the patient. It also denotes the period between each cycle. This period may vary by specialty. Some may be 15 days while some may be 30 days. Bill cycle will change only if there is no activity between two cycles. Bill cycle will be zero before the first bill is sent. Let us take a couple of instances to explain this.

For e.g. Patient JOHN SMITH is a self-pay patient.

Case # 1: He has a bill for DOS 12/01/2007 for $50. The bill was sent on 12/06/2007. The bill cycle will be 1 after sending the bill. The patient paid $25 on 12/23/2007. The second bill was sent on 01/10/2008 for $25. The bill cycle will still be 1 after sending the second bill. This is because, the balance in the second bill is a fresh balance after the patient has paid.

Case # 2: After the first bill was sent on 12/6/2007, the patient comes back for treatment on 12/10/2007. The bill for both the dates of service will be sent on 12/13/2007. This is in addition to the bill sent on 12/6/2007. The bill cycle will still be 1 here. The patient pays for the first bill for $25 on 12/23/2007. After the next bill sent on 01/10/2008 the bill cycle will still be 1. If no payment or no fresh treatment occurred after the bill sent on 01/10/2008, then bill cycle will be 2 after sending the next bill on 02/14/2008.

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