Step 7 in the Medical Billing Cycle: Prepare and Transmit Claims

1. 1-16 Step 7 in the Medical Billing Cycle: Prepare and Transmit Claims • Medical practices produce insurance claims to receive payment • PMPs generate health care claims for electronic transmittal

2. 1-17 Step 8 in the Medical Billing Cycle: Monitor Payer Adjudication • When a claim is received by a payer, it is reviewed following a process known as adjudication—a series of steps designed to judge whether it should be paid • The document explaining the results of the adjudication process is called a remittance advice (RA) or explanation of benefits (EOB)

3. 1-18 Step 9 in the Medical Billing Cycle: Generate Patient Statements • A statement lists all services performed, along with the charges for each service • Statements list the amount paid by the health plan and the remaining balance that is the responsibility of the patient

4. 1-19 Step 10 in the Medical Billing Cycle: Follow Up Patient Payments and Handle Collections • The accounting cycle is the flow of financial transactions in a business • PMPs are used to track accounts receivable (AR)—monies that are coming into the practice • PMPs are also used to create day sheets, monthly reports, and outstanding balances reports