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Medical Billing as a Profession

We can't discuss medical coding unless we also speak about medical billing, so closely are these two tied in with each other. Both discipline's goal is to assure that medical reimbursement claims are promptly processed and submitted to health insurance carriers, and the health care provider and facility gets paid for medical services rendered.

A Good Medical Biller Is...

As the saying goes: A good medical biller is the provider's key to getting paid!". In order for the doctor's medical practice, clinic, or hospital to prosper the medical biller must know the concept of a clearinghouse, and an A/R, and understand how to verify insurance coverage, determine eligibility, collect data, submit all claims, avoid denials, contact patients, and communicate with insurance companies to ensure the highest possible return of revenue for their emplyer, or client.

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There are over 819,000 physicians and surgeons; 2.4 million registered nurses, 77,000 occupational therapists, 182,000 physical therapists, and 94,000 respiratory therapists, and millions of other allied health professionals in America's hospitals alone.

Medical billing for facility-based providers is different from billing for non-facility based providers; just like inpatient coding is different from outpatient coding. Health care provider billing involves submitting claims for individuals, such as physicians, chiropractors, nurse practitioners, physical therapists, and podiatrists, etc.; hospital billing involves claims for inpatient services, which, in turn is different from ambulatory emergency services.

Medical billers use a personal, or company issued computer daily, and are expected to know a variety of computer programs to create and update databases and spreadsheets. This means they have to sit for hours, and focus their attention at a computer monitor, which in some cases may lead to eye and muscle strain, backaches, headaches, and sometimes repetitive motion injuries.

Submitting Medical Claims

Submitting medical claims is just as diverse as any other job. The medical biller must know the claims processing guidelines for common health care plans, such as Blue Cross/Blue Shield, Tricare, Medicare and Medicaid, etc, and state regulations that apply. There are three basic areas for billing:

• inpatient hospital 
• outpatient services 
• physician billing 

Along with other sub-areas of specialized billing, such as for DME (durable medical equipment), and for home health care, these are the three areas most entry level medical billers are expected to handle.

Do Medical Billers Code?

Medical billers are NOT the people that code. Why? Because they are not trained in it, and if they do it anyway without the proper background in training, or experience it creates liability for them and the firm. However, experienced medical billers usually have knowledge of some coding in order to review and verify the accuracy of a medical bill. It is well within their scope to verify that the codes selected by the provider are true and correct. Medical billers also use their knowledge of different health insurance plans, provider contracts, and state rules and regulations to get denied claims overturned and paid when the denial was incorrect.

What are Billable Healthcare Costs? 

The biggest segment of health care cost and expenses comes in form of bandages, prostheses, devices, implants, medications, equipment, apparatuses, and countless other items required for modern care. These items and the services associated with them must be properly coded and billed to the patient, or their health insurance provider for reimbursement. This also includes wound care, and hospital stays. Understanding the reason for an insurance company's claim denial is very important.

1. Coding vs. Billing Expert
2. On Medical Biller's Training
3. On Medical Biller's Work
4. On Medical Billing's Future