What do medical billers do? medical billing news!

Medical Billing Specialist Duties
Medical Billing Specialist work with physicians, medical centers. clinics, insurance companies and other medical professionals who require a professional billing service. The main function of many medical billing specialists is to prepare medical claims for processing and send them to a private insurance company or medi-care agency for evaluation and payment. Other duties might include:

Following up on rejected claims
Billing patients for deductibles
Compiling data
Posting data
Billing patients for co-payments
General maintenance of patient records
Medical Billing Specialist Skills

These are the basic skills needed to enter this field:

Excellent word processing skills
Familiar with medical billing rules
Know medical regulations to process medical forms
Know medical coding system
Know medical terminology
Know electronic billing procedures
Know insurance processing procedures
Managed a medical office
Courses in managing a medical office
Medical Billing Specialist Equipment


http://smallhomebusiness.suite101.com/article.cfm/medical_billing_specialist#ixzz0IanRdPTC&D

Accounting for your own business - medical billing news!

There will be a point where you get too many clients to manage your own books. It happened to me. BUT, I thought of my need to outsource MY bookkeeping and acounting made sense for me for a couple of reasons; 1. it freed up my time to concentrate on my business and 2. I AM AN OUTSOURCED SOLUTION, so outsourcing MY bookkeeping made sense. I wasn't afraid. Imagine if no one outsourced? WE WOULDN'T HAVE JOBS AS MEDICAL BILLERS, so remember this as you review and work your own books. It is extremely time- consuming and takes away from your core responsibilities. Something to think about... My bookkeeper and my accountant are worth every penny!

More than one location per provider - medical billing news!

Several of your providers MAY work in different locations throughout their typical work week. Some have multiple office locations, or they work rounds at the hospital. In this case it is required that these additional locations be added in the Facilities section of your software or database. Without this information, claims will go out with the incorrect Place of Service causing billing complications and/or denials.

Medicare Re-enrollment - medical billing news!

Re-Enrollment has changed quite drastically from 27 months to 30 days, so something to be aware of. Also, if a change of address or location is not made within 30 days, there’s the risk of being expelled for 2 years. This comes at a time when many physicians are actually dropping many Medicare and Medicaid patients. The changes must be registered with the Medicare contractor.

One large concern is the paper flow as a physician could go to work before the initial process is completed for enrollment. The AMA is pushing to get the deadline extended for such changes to 90 days. Practices are not holding off on purpose, it’s just that there’s some real big mountains of administrative work that pile up today.

If the contractor denies enrollment instead of rejecting there’s a 30 day window for the physician and contractor to rectify the initial errors, so this could also offer some relief. Guidelines state that internet enrollments should be within 45 days, while 60 days is the expected time frame for those enrolling with paper.

Don't just get software; GET A BUSINESS PARTNER!

It is all too easy to select a software provider, as a medical biller.
At least it sounds easy...
Well, it's not.
What should you look for?
1. Customer service and availability
2. Ease of use
3. Technical support and their availability
4. Clearing house information and workings
5. Company size
6. Country of origin
7. What they do when you are in a bind for help
8. Staff turnover
9. News and press
10. References

Align yourself with an internship program - Medical Billing News!

One of the most important parts to any medical billing program is the opportunity for students to get real experience by working in an externship. Externships allow students to leave the classroom setting, and to work in an actual medical billing office. This not only provides great experience, but it also might provide a job recommendation when you start looking for a billing and coding job after graduation. Vocational schools can never promise you a job, but they can help you get experience in an externship - which is a step toward getting a real job. Check with the medical billing program near you to find out if they offer an externship or internship program for students and/or graduates.

As a medical billing business owner, aligning yourself with an externship program can be one of the smartest decisions that you can make. These folks are fresh out of school and are extremely eager to learn and to help out. Importantly, this relationship or arrangement can help the medical billing business owner tremendously. After all, it is free labor which is every business owner's dream especially in the business building stages - obvioulsy as long as the externs are honest and capable.

Get an attorney - don't go it alone!

I cannot stress enough the importance of having an attorney review all of your documents, especially your contract or agreement.
It is so important to protect yourself as the medical biller.
Also, do NOT ever change the language on your own. If a potential client requests a change in terms or in the language, take that request immediately to your attorney to discuss and review.
Many people have been hurt by "inocently" editing their contract. It ALWAYS bites you in the end. So, tread lightly.

Chosing a medical billing software - medical billing news!

Prior to purchasing medical billing software and making thousands of dollars investment please read reviews listed regarding the various Medical Billing software programs available. Some practices we've seen have not asked the right questions. The salesman in general will only cover the most common features of their medical billing software, and is not in it to train on how it works.
This of course would be a bit counter productive as some experienced billers are the toughest to train. Experienced billers are experienced in their current software and requires an open mind and patience while learning a new way i.e. online or web-based medical billing. Ironically, some trainings I've attended have included an inpatient experienced biller that was challenging the software and how it should work i.e. like their old medical billing software. The trick is asking the right questions and making sure the salesman puts it in writing so you can back up promises made.

How to create a medical billing contract - medical billing news!

Creating a contract to be used for medical billing is a total necessity, but can get expensive.
Your contract should consider BOTH parties.
Not only a business agreement and strategy, but an EXIT clause needs to be included.
Always be certain to check with your attorney before using ANY medical billing contracts. Most of those out on the internet, even for purchase, are guidelines and/or samples.
Don't make a mistake by purchasing and immediately using such a contract without consulting an attorney. Remember terms change according to circumstance and state, so check your requirements!

Is it possible to run a medical billing business WITHOUT a computer?

The answer is YES, but NOT without pain.
Without a software program or method to submit medical billing claims electronically, you would need to do the following:
1. Purchase and house the latest CMS 1500 forms.
2. Complete each claim / form by hand.
3. Mail the forms in and cross your fingers in hopes that they make it to the insurance carrier.
4. Follow up by phone beginning 4 to 6 weeks after sending to confirm receipt at the insurance carriers.
5. Call again in another 4 to 6 weeks to check the status of them being processed.

As you can sense, it is possible to run a SMALL medical billing business without a software and without technology, but it is CHALLENGING. Again, possible.
So, if funds are an issue, do a little research and go with what you have even if it's a paper and a pen to get yourself going.
Know that once you have a couple of clients, you CAN invest in your business by purchasing a software. Visit www.MedicalBillingFoundation.com for software informatin and for a no-obligation, free demonstration today!

The importance of a computer system - medical billing

One of the most important and possibly the most costly purchases for today's medical practice is the office computer system. Computers are used for a variety of purposes, even if the billing aspect is outsourced, as is often the case. Large groups and small practices alike use the Internet for connectivity to other businesses, such as hospitals, pharmacies, insurers and vendors. The office staff can even order lunch via the Internet, or place their orders so their groceries will be delivered when they arrive home from work. In addition to Internet use, the office computer can be used for word processing and document creation, appointment scheduling, fax transmittals, bookkeeping and voice dictation. It does not matter whether you are buying your first or your fifth system, selecting the right setup for any size practice can be a mind-boggling experience. To those who think buying a car or house is one of life's biggest nightmares, be forewarned that by comparison choosing and purchasing a medical computer system makes those look like child's play.

Tips for submitting claims - medical billing news

Helpful hints to reduce claims processing time!

Submit claims electronically. ODS processes electronic claims first each day.
Verify the patient's relationship to subscriber and plan information is correct before submitting claims.
Include all pertinent information. Date of birth, subscriber ID, valid CPT and ICD-9 codes.
If the patient is covered by more than one ODS program, submit one claim form indicating the name of the subscriber, subscriber ID, employer (if applicable), and ODS group number for both plans. If covered by another carrier, indicate the above information plus the name, address and policy number of the other carrier.

If a patient has primary insurance through another carrier other than ODS, the EOB from that insurance company will need to accompany the claim for consideration of payment.
ODS makes payment twice per month.
Please contact us before submitting duplicate claims:
Re-billing without contacting us slows our turnaround time and delays payment.
Check Benefit Tracker to see the status of a claim. If you haven't registered for this free online service, click here for more information.
If you receive a PDR indicating that your claim has already been processed before you receive a check, this indicates your re-bill was unnecessary. The claim was processed and is pending for the next scheduled payment date.
DO NOT USE HIGHLIGHTER ON PAPER CLAIMS.

Large medical billing firms

The days of medical billing where you walked into a doctor's office and the receptionist was busy printing out the few bills she had are long gone. Today, most of the medical billing that is done is done by very large companies. While this may seem more efficient and certainly more profitable to their customers, there are many pitfalls that a large company can fall victim to. In this article, you'll read some basic tips that large medical billing companies should follow in order to get the most out of their operation. Hopefully, by following these tips, you'll save yourself a lot of grief and heartache over the course of time.

The first and probably most important thing, is for the company to set itself up in such a way as to maximize productivity and at the same time minimize the risk of running into serious problems. One way to do this is to divide the billing responsibilities up among departments. If you're representing a large client base, you'll probably want to have one section of the staff handling billing for doctors in private practice. These will probably be your smallest accounts and as a result, you'll have to dedicate the fewest resources to this section. Another section should be assigned to handle the billing for large facilities. This is where the bulk of your billing will probably come from and you're going to want to have a large enough staff to handle it.

The next thing you're going to want to do is setup your software in such a way that it allows for growth without having to worry about your network getting bogged down. This is probably the most complicated part of the process of setting up an operation. It's often very hard to look into the future and see how much volume of billing you're going to do. But if you intend on going after the facility market, there is a very good chance that your operation is going to grow at a rapid rate. How do you prepare for this?

For starters, you're going to want to do the same thing with your software as you did with your departments. You're going to want to split up your databases into departments as well. You'll have one database for each item in your software for doctor billing and another database for facility billing. You will probably want to further break down facility billing into two sections of the alphabet. Possibly have one database for patients and facilities from A to M and another database for the letters N to Z. This will need to be done for all databases in the system.

As you have broken down the databases, you're probably also going to want to break down the staff as well, having half the staff take care of all patients from A to M and the other half taking care of patients from N to Z.

The above only scratches the surface as there is also the issue of forms, networking, software updates and a number of other issues. The point is, you're going to have a large operation and breaking it down into separate parts will make your company as a whole more manageable and ultimately more profitable.

Michael Russell

Denials are not always clear cut ! The hunt is on!

After being a successfull medical biller for several years, there are thing about the insurance carriers that you just figure out.
For example, insurance carriers "mistakenly" deny claims occasionally.
Yup, it is true. I know how shocked you are! LOL.
Anyway, the PAIN of this is that it is YOUR job, as a professional medical biller to follow up on those denials, offering outstanding medical billing service.
It is a painful fight, but understand that insurance carrier often deny a claim because A.) they can B.) They doubt anyone has the time to challenge it C.)they can - yes, I said that twice.
The point is that it is challenging to followup on every single denial. The good news is that MOST carriers give you one entire year to challenge a denial, so breathe.
You have a lot going on as a medical biller. This is just one more piece of the pie.
Good luck and visit www.MedicalBillingFoundation.com for more info!

Medical Billing Service for heavy PIP & WC clinics

Some Medical Billers tend to shy away from medical practices or rehab centers that deal heavily in PIP and Workman's Compensation claims.
I do just the oposite.
Yes, there is more work involved and yes, there is a lot more paperwork, BUT the return from commercial insurance carriers is HIGH.
The health carriers will reimburse approximately 30% of what was BILLED.
PIP & Workaman's Comp carriers (or commercial carriers) reimburse more like 80 to 100% BILLED.
Something to think about...