Medical Biller's Importance
Medical billing is a complex procedure and the medical biller requires a fairly broad range of knowledge and qualities. When a practicing physician or licensed healthcare provider has an encounter with a patient, the provider wants to get paid for the services. But wait! Who makes sure the provider get's paid??? That would be the medical biller's job.
For Example:
Think about the large number of medical specialties, large number of medical conditions and diseases, large number of CPT codes, large number of Medicare rules, large number of health insurance companies (payers), and large number of patients!!! Wow... that's huge! If the patient has medical health insurance the medical biller will file a claim on his/her behalf.
If the practice administers 50 different procedures and works with 50 payers, then 1,000 monthly charges require selection from 2,500 unique fees defined by contractual agreements or “reasonable and customary pricing” (“allowed”) for every CPT-payer pair. The insurance carrier determines if benefits are payable. The medical biller's role in this process is to translate medical terminology, diseases, diagnoses into coded billing statements, enter patient information into databases, mailing patients’ billing statements, posting payments received, follow up on unpaid insurance claims, as well as appeals and denials, and report to their employers on the financial status of the practice.
The Art of Medical Billing
In a small family practice or suburban clinic this task may be simple and assigned to the medical assistant or secretary who works at the front desk, but in bigger (group-) practices and clinics this task is the medical biller's job! Medical billers reviews charge slips that list the services and procedures commonly performed by the healthcare provider and informs patients of any charges.
To get paid an Assignment of Benefits (AOB) is used, which is an authorization directing the insurer to make payment directly to the provider of benefits, rather than to the insured. The insurance carrier however, is the one who determines whether benefits are payable. After a patient visit they review superbills or encounter forms to determine what services were rendered, review the patient's insurance coverage, explain physician's fees, estimate what charges will be covered by insurance, estimate how much patients might pay, and prepare accurate healthcare invoices and claims. They are the ones who organize medical bills and statements, comb through them for errors, negotiate with collection agencies, answer patient's questions about their health-care plans and the office's billing routine, and spend hours on the phone with insurance companies on a client's behalf.
A Highly Skilled and Knowledgeable Expert
Medical billers use the HCFA-1500 form, the universal billing form to submit health insurance claims to insurance carriers. They must know appropriate responses to a variety of billing and legal situations. Bill collection, release of patient information/records, patient confidentiality rights, subpoenas, workers’ compensation rules, and Medicare regulations for reimbursement are complicated areas and must be handled competently and with care.
Medical Biller's Books and Software Programs
Medical billers accomplish their tasks using reference books, printed guides and references, automated office equipment, and computers with various sophisticated types of software. Software is used to file claims electronically, apply all patient and EOB payments, print statements, update management reports and all patient data files. Medical billers usually possess state-of-the-art word processing and accounting skills, are proficient in bookkeeping, and type at a speed of at least 45 words-per-minute.
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