The patient is admitted to the hospital for treatment or surgery.
All services provided during the hospital stay, including surgeries, lab tests, and medications, are documented in the patient’s medical record.
Hospital coders assign ICD-10 codes and DRGs based on the documented services and diagnoses.
Charges for all services, including room and board, procedures, and medications, are entered into the hospital’s billing system.
The hospital submits a claim to the patient’s insurance company for reimbursement of the services provided.
The insurance company reviews the claim, processes it, & makes a payment to the hospital based on coverage and the services provided.
The insurance payment is posted to the patient’s account, reducing the balance owed to the hospital.
The patient is billed for any remaining balance after the insurance payment is applied.
The hospital follows up with the patient to collect any outstanding balance, sending reminders if necessary.
The patient’s account is settled when the payment is made, concluding the billing process.
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