1. Sample workflow when patient does not have insurance
Patients who are not covered by health insurance(do not have any insurance) are considered “self-pay” patients. They or the responsible party they designate are responsible for their bill. Not everyone is covered by health insurance. The ones that aren’t covered are considered self-pay and just like in the old days, these people must pay for their visits themselves.
- Patient Calls / Walks to the Physician(or Doctor or Provider) office to fix an appointment.
- On the Appointment day, the patient checked In to the office and give all the demographics information(last name, first name, DOB, address, etc).
- Doctor check the Patient Previous medical record and does the treatment to the patient for the current problem(or Disease);
- Each treatment represents a code and that code is called CPT. It is also called Procedure Codes; So for each patient visit, the doctor choose the correct CPT Code;
- Once all the processes are over, the now patient leaves the doctor's room. Now the doctor office to get paid for the service provided to the patient;
- Since the patient has health insurance, so patient leaves(checked out) the clinic and ask the clinic to get money from the insurance company;
- Now the Billing department of the Clinic prepares the Bill(Claim) by entering all the necessary information. This process is called Charge entry or Charge Posting;
- Once the Claim is prepared and since there is no insurance for the patient, so the patient statement is generated and send to the patient for payment;
- The patient Receives the Statement and Payments are made to the doctor's office.