Medical Coding and Billing
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Doctor - Do You Know?

How to Interview a Medical Biller

This article is designed to give you, the physician some ideas of how to screen your potential medical billers. You are busy and have limited time to devote to the interview process, but it is very important to fill this position correctly. The guidelines below will help you find the most experienced medical biller for your specialty, ensure long term employment and help get your money in the fastest was possible.

By Cathie Boddie, republished with permission


Defining ”Medical Billing Experience”

Salary levels are always a consideration. You will most likely need to pay a higher salary for an experienced medical biller. It will be well worth every penny, as the right person will increase your income. While interviewing your candidate, ask specific questions about the type of medical billing they have done in the past. It is important to break this down, as there are misconceptions as to what type of work is actually considered “medical billing”. Many think if they have 8 years of working in a doctors office, they automatically have medical billing experience. However, it really is “posting” or “data entry” work they have been doing. This work is important as the data is used for billing purposes, but it is not the type of experience you need to fill the medical billing position.

Posting or data entry experience

  • Typing in CPT and ICD-9 codes you have circled or checked
  • Entering co-payments from the patients
  • Verifying patient’s insurance coverage
  • Entering patient demographics
  • Calling insurance companies to ask why claim not paid
  • Ability to print and mail HCFAs/CMS 1500

Medical billing experience

  • Writing appeal letters - Have them explain the process
  • Work the A/R reports - Have them explain what type of reports in detail
  • Finding the right codes for a specific specialty
  • Using modifiers properly
  • Developing more efficient Superbills/Fee Slips
  • Handling difficult self-pay and workers’ comp issues
  • Responding to billing inquiries in person, mail and telephone
  • Maintaining a high level of customer service regardless of the behavior of the patient or patient family member
  • Updating the codes in your computer and fee slip each year
  • Able to read, understand, and explain insurance carrier’s contracts
  • Able to read, understand, explain, and fight regarding insurance companies use of different codes to deny proper or full payment of a claim from EOB
  • Able to properly help you with credentialing process
  • Understand, explain, and handling referral/authorizations
  • Understand, explain, and handling pre-authorization & verifications
  • Understand the state law for worker’s compensation
  • Understand and explain and follow the Federal Fair Debt Collection Rules
  • Understands HIPAA and can follow the rules
  • Able to understand the difference between a “write-off”, insurance adjustment, and Financial hardship adjustment, capitation adjustment and how they differ

Understands and can explain how evaluation and management codes work. How are physicians suppose to know how to pick the right codes? Is it time only? Is it gathering and reviewing patient personal and family history, examination details, and decision making process?

Ready to Prove Themselves

Most senior medical billers will come to an interview prepared to show you they can do the job in the most skilled manner and to show you they are the “real deal”. No one can memorize all of the codes, but they should know how to utilize them properly - so you must test them.

Bringing up-to-date CPT, ICD-9 and HCPCS books

  • They are ready to prove they know how to look up a diagnosis, procedures, or supply items. Even if it is one they have never heard of before, an experienced biller should be able to find it.
  • If they do not have their books, you can hand them yours and you will be able to tell how proficient they are using them.

Bringing a medical dictionary

  • This shows they are ready to learn and to be careful enough to look things up in the medical dictionary they may not understand at first.

Bringing a book on your specialty

  • If they purchased the book for your specialty, this means it was important to them to be ready for the interview.

Additional classes

  • If they are serious about their billing experience, they will do everything possible to keep up with the industry. You need to ask specific questions and make notes on their answers, which you can expand upon their 2nd interview if they make it that far.
  • What classes have they taken to enrich their billing experience and which ones did they find the most helpful and why?
  • Ask the name of the class or seminar and who paid for it? Was it their employer, themselves, or was it free through the insurance company? Was it a one-day or a two-day seminar? How long ago was their last training class?

 

Test Their Skills

It is important to have the candidate show you they can do the work you need them to do. Test their skills on some of your specific billing codes. They should ask you questions!

Five procedures

  • Provide on paper, the word descriptions of 5 procedures. Let them find the correct codes.
  • Does this procedure have options and different degrees/levels (such as full thickness repair, simple repair, and if size of wound area or lesion repair is important for the right CPT code)? If so, the medical biller should ask you if this was a full procedure or staged procedure.
  • If it is relevant then they should ask if it was a right side, left sided, or bilateral procedure.
  • They would have to ask also was there another procedure/operation that might be within the global period/post op period? If the answer from you is a “yes”, then the follow-up question would be is this procedure related to that procedure. Your answer will tell them what kind of modifier they need to add to the correct CPT code.

Five diagnoses

  • Provide on paper, five illness/symptoms/diagnosis and have them find the right ICD-9 code.
  • If you wrote down maxillary sinusitis, then it is important that the biller know enough to follow-up with a question or to ask to look at the chart to find out if this is acute or chronic.
  • They should not just select the first code they find without researching if they need to find the 4th or 5th digit of the ICD-9 code to be complete.
  • You always want to steer away from any person who is obviously guessing. We never use the index for selecting a code. The index is for guidance only. If you see them choosing the code from the index alone without going to the numerical section to read more about the code and choices to be made, you don’t want to hire this person.
  • One of the main ways to get a clean claim through is to be as specific as possible on the ICD-9 codes. Stop using the “unspecified” codes, unless there is no other diagnosis that will work. Don’t even let them be an option, unless it is absolutely necessary. It is better to code the symptoms instead of coding unspecified. You should get them off your fee slips/encounter forms and out of your computer.

 

Ask Them Questions

You will be working closely with this person so you need to be certain you can converse with them and vice a versa. This will also test their billing knowledge. These are sample questions and might vary depending on your specialty.

  • Explain to me how you would go about getting paid for a surgery I did that Medicare says is included in a previous procedure or service?
  • Why is it important to verify coverage of all patients prior to their arrival? How would you handle a self pay patient at the front desk who does not think he should pay now that he has already received the service from the rendering doctor?
  • Was there any doctor or patient in your last practice that you will always remember for one reason or another? If they give out full names, or even last name of patients - breaking HIPAA - you can then follow-up with the next question.
  • What is HIPAA? How does it daily affect a doctor’s office like mine?
  • Can you appeal every denial that I get from the insurance company for me?
    The answer should be no, you can only appeal the improperly denied claims; an inexperienced biller is going to want to say YES. An experienced biller knows you can’t appeal and win everything. You must use your time and energy wisely going after what you can win.
  • Ask them if they got hired, what Reports would they run and why? Ask them what else would they do the first week? The answer should be something like this: I would run and A/R report for the practice as a whole for the last 1 year to 1 ½ years with aging buckets 30 60 90 120 and over. I would run a productivity report for the practice as a whole and then for each individual provider. The productivity report usually will show what CPT codes you have used and how often. I would run an A/R report for all the insurance carriers and then each one individually. I would run a report on the patient A/R separate from the insurance A/R report. If software will allow, I would run a report on what adjustments have been take over the last year. How much has been “adjusted off” and it should have categories as to the reasons why. I would be reviewing this to see if maybe we are taking too many adjustments off instead of fighting back with the insurance company or getting a little firmer with some of the Self Pay patients.
  • Ask them to explain the Federal Fair Debt Collection Act/Policy?

 

In Conclusion

Medical billing is not a job that we dream of as little children, “When I grow up I want to be a medical biller so I can argue and beg with insurance companies all day!” No, that doesn’t happen. However, the potential medical biller will view the job as if they were solving a mystery or problem. They will do this with proper research, knowledge and following the detailed trails to/from the insurance companies. They will also care about what you do and your reputation.

If you already employ a person with the right personality to be a medical biller and they know your specialty, Cathy Boddie offers on-going billing training classes for those in the Alexandria, Virginia area.

 

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About EYE Bill FOR YOU

Based in Virginia with over 20 years of experience and a broad range of medical billing knowledge, EYE Bill For You offers HIPAA compliant medical billing for many specialties. Our medical billing outsourcing solution is offered in the Virginia, Washington DC and Maryland areas.

Cathy Boddie (owner) has an established reputation for helping doctors lower their accounts receivables by examining super-bills and improving them to increase reimbursement levels. Cathy has taught students in medical billing and coding at Northern Virginia Community. Cathy has provided lectures and training sessions on medical billing and coding, Self Pay Issues, and working with Embassies accounts at Georgetown University Hospital and Medical Center: http://www.eyebillforyou.com .

EYE BILL FOR YOU
Cathy Boddie, Owner

For permission to republish the above article, please contact Cathy Boddie.