Medical Billing Cycle - Healthcare

Demo Entry in Medical Billing

Channagangaiah

Demographic Entry is the process of entering or capturing the accurate patient information (Like Patient details, Guarantor details and Insurance details) into billing software for filing a claim. Patient information is collected by the doctor office from patient at the time of registration through patient registration form.

Demographic Entry is the first step in medical billing and plays a very important role in order to submit the claim as clean claim to the insurance company. If the information updated is an inaccurate, then it may lead to rejection from the clearing house or denial from the insurance company.

Let us see in details of capturing the patient information during demographic entry process:

Patient details captured into billing software are as follows:

  1. Patient Name
  2. Date of Birth of the Patient
  3. Marital Status of the Patient
  4. Gender (Male/Female) of the patient
  5. Social Security Number of the patient
  6. Physical and Mailing address of the patient
  7. Home Telephone Number of the patient
  8. Work Telephone Number of the patient

Guarantor Info:

  1. Guarantor Name of the patient
  2. Guarantor Date of Birth of the patient
  3. Guarantor Gender of the patient
  4. Guarantor Marital Status of the patient
  5. Guarantor Social Security Number of the patient
  6. Guarantor Physical and Mailing address of the patient
  7. Guarantor Home and Work Telephone Number of the patient

Insurance details of Primary, Secondary and Tertiary captured into billing software are as follows:

  1. Name of the Insurance companies patient owes
  2. Address of the Insurances
  3. Policy Identification Number of the Insurances
  4. Group Number of Insurances
  5. Effective date of the Policy
  6. Termination date of the Policy
  7. Name of the insured or subscriber details
  8. Relationship of the insured to the patient/guarantor

Why Demographic Entry Process plays an important role in Medical billing cycle?

Demographic Entry Process is the first step in medical billing cycle and as per the analysis, one of the top reasons for claims are getting denied is because of Invalid or incorrect patient information filed to the insurance company. This directly effects the quick reimbursement of the claims from the insurance companies.

Below are the lists of top denial reasons, if the claims are filed to an insurance company with an inaccurate patient demographic entry:

  • Incorrect/Invalid Patient information
  • Patient cannot be identified
  • Patient name incorrect
  • Patient DOB incorrect
  • Patient Gender incorrect
  • Incorrect Insurance ID

For examples:

Example 1:

Assume Demographic Entry Team keyed the incorrect BCBS insurance details instead of UHC insurance for the patient Alex and submitted the claim through paper.

BCBS insurance adjudicates and denied the claim as patient cannot be identified (BCBS insurance doesn’t have details of this patient in their system).

Example 2:

Similarly assume patient Gender entered incorrectly as Male instead of Female.

As we know some procedure code are listed based on patient’s gender, in this case if procedure code listed and patient’s gender mismatch claim will be denied.

So an accurate patient demographic entry is the first step in the medical billing cycle for submitting the clean claim and gets reimbursed very quickly if everything seems to be correct. Demographic entry is the first important steps which need to be entered accurately in order to avoid the rejection from clearing house or denials from the insurance companies.