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Medical Billing is the Fastest Growing Opportunity in Health Care

by: Jay B Stockman

On February 16, 2006 the Health Insurance Portability and Accountability Act was finalized, and enacted. This law is designed to establish national standards for all health care transactions, and to ensure the security and privacy of all health related information. The motivation behind this law is to improve the performance, and efficiency of our health care system. This type of reform has created a need for qualified individuals who can utilize the tools of this legislation, and assure full compliance, and maximum reimbursement. It would therefore be a prudent move for health care facilities to employ such individuals in order to avoid mistakes that could have dire consequences.

The proliferation of medical knowledge following World War II brought about an explosion of diagnostic, and treatment procedures. As a result, there became a need to organize, and standardize all these developing technologies. Here is where the foundations of medical coding were born. Medical coding met these challenges, and allowed for a more uniform way of communicating health information under a common language. By January 1979, standardized definitions, and codes were adopted, and used by health care providers, and insurance companies. Since improvements and refinements of medical procedures are constantly being developed, codes must be added and updated to reflect these changes. Today, the number of medical and surgical procedures have become enormous, so too have the codes to describe them. These overwhelming numbers of codes and protocols have made outsourcing medical billing the standard.

Medical Billing and related occupations continue to be the fastest growing opportunities in health care. Insurance institutions and government agencies are investing huge resources to control claims� fraud, abuse, and establish some degree of reimbursement parity. As a result, more insurance companies, and health care facilities are looking

Today, evolutions in the health care industry are happening at a very high pace. It is only with the assistance of sophisticated computer programs, and standardized coding procedures that medical coders are now able to describe and characterize the tremendous number and various kinds of medical and surgical procedures.

to medical billing experts for help. These companies and practices are looking for experienced and educated individuals; the legal consequences of incorrect billing could be devastating. There is a movement in the industry to make medical billers responsible for inaccuracies, much they way accountants are for tax returns.

At present, there are no standards for educational requirements for medical billers and coders. However, more employers are looking for some formal training at an accredited career training institution. These schools range in training time from nine months to two years, anything less would not be considered adequate. There is a move for certification, and several organizations are sponsoring certification examinations in medical billing and coding. Medical billers and coders earn as much as $8 to $10 per hour in the beginning, and could potentially realize $30 to $40 per hours with experience and additional responsibilities.

Today, evolutions in the health care industry are happening at a very high pace. It is only with the assistance of sophisticated computer programs, and standardized coding procedures that medical coders are now able to describe and characterize the tremendous number and various kinds of medical and surgical procedures. These realities coupled with government regulations, and health insurance guidelines have contributed to the strong demand for experienced medical coders and billers.

About the Author

Jay B Stockman is a contributing editor for Medical Billing Resource. Visit http://all-medical-billing-software.com/ for more information.

Dr. Jay B Stockman is an individual contributor to Google Health Co-op

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Effective Medical Billing: Get Paid On Time

By: Pinky McBanon

Timely medical claim reimbursement/payments for the medical provider are a serious problem by most of medical practices nowadays. How can a medical practice survive with slow revenue? too many claims denial and rejection? The solution here is to get the collection done as effectively as it can.

Empirically, insurance companies will delay or deny claims payments! They are very slow on medical reviews, predetermination and processing claims. I think, that is one of their business strategies in doing business. They are too is running their own business' revenues. But if you are a good medical biller, you are aggressive and can effectively collect payments in less than the time your provider expects.

Having an effective office manager in your practice that knows the administrative task is very important. As a provider, you should be more focused on your patients' care and not on how you run your practice. Your patients must know their benefits and eligibility. Encourage your patients to contact their insurance company regarding their unpaid claims. The insurance is more attentive when the member makes the phone follow up.

As a medical biller myself, I can collect Medicare payments by "paper billing" in less than 2 weeks!, you can imagine the electronic claims submission. I refuse denial and rejection, because I believe, if the medical service have been rendered, it is just right to have it get paid. Many of my provider clients just give up, but, well, I don't. As long as he wants his payments, I never give up collecting his money.. at the end, we were successfully got paid. It is just a matter of how you deal with the insurance and aggressive follow-ups.

Medical claims should be submitted on a daily basis. Never delay claims submission. Promptly respond "immediately" to insurance letters that you receive, if they require additional documents, such as, medical referral, medical prescription, progress notes and letter of medical necessity to process the claims. Always comply what they require to expedite processing of the claims.

As a medical biller, you should also be a medical coder. The doctor gives the diagnosis description on the script but usually always with the wrong diagnosis code. It is not their concern to code a diagnosis, but to descriptively provide the diagnosis. You must know how to analyze and help your provider submit the right diagnosis code. Analyzing the proper and right diagnosis code is also very effective to get paid. Remember that when submitting your claims, the insurance company does not read your diagnosis' description. They process claims based on the right procedure codes and based on medical necessity (diagnosis code) Right procedure, service and supplies coding is also very essential in submitting your claims (CPT/HCPCS, Modifier Codes). There are procedures that the insurance denies for payment because it is NOT medically necessary based on the diagnosis on the patient. You should understand each insurance company's payment/fees guidelines.

But here's the thing, "if" the insurance company still keep on denying your claims, then it's time for them to get notified, they will be reported for non-payment of claims to the proper agencies/bureaus if they don't process your claims in 15 days!. I think, this time they will be more attentive.

Now, here is another issue, you should choose a medical billing company that will help you do all this. It is going to be a big decision that you have to make. But here are the things that you have to consider in making that decision:

(1) Able to handle accounts regardless of the medical practice account's size

(2) Electronic & Paper Billing Capability with fast-turn around time

(3) Experienced in analyzing proper procedure and diagnosis coding

(4) Lesser claims rejection/denial. Efficient in filing of appeals for denied claims

(5) Knows how to submit claims on worker's compensation and "no-fault"

(6) Unlimited client support and able to provide full service medical billing

(7) and the most important thing, they strictly understand, follow and comply with HIPAA guidelines, rules and regulations.

The Author: Pinky Mcbanon is a Systems Engineer and a Medical Biller/Coder.

About the author:

The Author: Pinky Mcbanon is a Systems Engineer and a Medical Biller/Coder.

She shares her medical billing and coding expertise with http://www.medclaimsplus.com

And she shares her technical support expertise with http://www.fix-exchange.com (your online source for free computer technical support!)

Keywords: Medical Claim Medical Claim, medical claim reimbursement/payments, follow-ups medical claims, medical billing, medical biller, medical, medical practice, claims, claim, timely medical claim