Learn the procedures, steps, risks and requirements for medical billing.
Although you may not know it, medical billing services are an essential component of any doctor’s visit. Medical billing is the process of creating health care claims to submit to insurance companies so that payment for medical services can be obtained. The medical biller then follows up on the claim to ensure that your employer is reimbursed for the work performed. An experienced medical biller can increase revenue performance for the physician’s practice or the entire healthcare organization.
As you can see, medical billing is an ongoing practice in the healthcare field. This fundamental skill may not seem like an exciting prospect for new healthcare professionals, but it is a vital task they will need to learn. In fact, many medical assistants are trained to perform medical billing tasks in a variety of settings.
This article provides a detailed guide to the art and science of medical billing, one of the most important healthcare procedures for medical personnel.
Definition of medical billing
What does it mean to perform medical billing tasks?
Medical billing is the process of obtaining a patient’s insurance information, filing a claim, and following up or appealing claims with health insurance companies. The goal is to receive payment for services provided in a doctor’s office. It has medical coding reports that list diagnosis, treatment and prices.
What is the purpose of medical billing?
The goal of medical billing is to prepare claims and submit them to insurance providers. As a result of this process, the healthcare organization is reimbursed for the services it provides to its patients. Without this key step, a hospital or doctor’s office may not be able to operate or continue serving their communities.
How long does it take to perform medical billing tasks?
It is important to remember that the medical billing cycle consists of many steps that can take anywhere from days to months to complete. Accurate billing and timely follow-up are a top priority throughout this process. In most states, insurance companies are required to pay claims within 30 to 45 days .
Who can perform medical billing tasks?
While several healthcare professionals may be qualified to perform billing duties, it is typically a job designated for medical billers or medical office administrators (MOAs). The MOA is a multi-skilled healthcare professional who plays a crucial role in organizing and managing data in a medical office. They are also known as medical records and health information technicians. Medical office administrators use various systems to code and categorize patient information for insurance reimbursement, databases, and records.
Medical assistants can also play an important role in billing duties. Because they perform both clinical and administrative job functions, MAs learn basic coding techniques in most training programs. Medical assistants can also obtain certification in medical coding. For example, they can obtain certification from the American Academy of Professional Coders ( AAPC ) or the Board of Medical Specialty Coding ( BMSC ). The background and education of an MA can be incredibly helpful in pursuing certification or even a medical coding career.
(Click here to learn how to become a medical assistant .)
Medical Billing Training Requirements
Requirements for medical billing may vary and depend on your location or profession. Aspiring healthcare professionals will typically receive this training through their educational programs . For example, most aspiring MOAs in the United States will require a post-secondary certificate. Some employers may also require an associate’s degree. Typically, formal training can take between nine months and two years to complete.
At Unitek College, we offer a Healthcare Assistant Program that could give you a huge advantage in the field or when applying for healthcare positions. Our courses include taking vital signs, medical office administration, medical law, pharmacology, diagnostic imaging, etc.
Medical billing procedure
With these steps, you can begin to learn more about the medical billing process. Of course, like most skills, medical billing takes time and practice to do well. Remember to follow your facility’s rules and ask for help when necessary.
Medical billing steps
Here are some general guidelines that healthcare professionals should follow when performing medical billing tasks:
Initial medical billing
- Registration: The first step in processing an insurance claim begins when patients contact their provider’s office to schedule an appointment.
- Eligibility Verification: Before you can receive payment for services provided, you must verify that these services are included in the patient’s health plan.
- Point of Service Collections: Now that you have learned the benefit information during the verification process, you will be informed of patient financial responsibility. This will allow you to collect the co-pay, deductible, coinsurance, or full balance due when the patient comes to the front desk.
- Encounter Form: An encounter form, also known as a superbill or payment ticket, is created for each patient encounter. This form contains a number of common services, medical codes, patient demographics, and doctor’s notes.
- Departure Date: At this point in the process, you can schedule a follow-up appointment as needed and confirm that the doctor completed the consultation form.
Back-end medical billing
- Charge Entry: Use the encounter form to verify what procedures were performed and why they were performed. The charge entry staff will then enter these charges into what is called the practice management system. They will also include any payments made by the patient at that time.
- Claim Generation: Once the charges and payments have been entered, the claim can be generated. This process may include compiling charges, revenue codes, and more.
- Claim Scrubbing: As you prepare the claim, you will “scrub” it to ensure that each procedure, diagnosis, and modifier code are present and accurate. Purging claims also requires that patient, provider, and visit information have been completed.
- Claim Forms: As a medical biller, you will typically use one of two claim forms to receive payment from insurers. These forms are the CMS-1500 claim form and the UB-04 claim form.
- Claim Submission: The provider organization (i.e., your employer) can submit claims to payers electronically. Typically, medical billers use software that meets HIPAA electronic filing requirements.
- Claim Tracking: Please note that your part does not end once a claim has been filed. You should also check the status of each claim daily. If clearinghouses (i.e. brokers) are used, they often have dashboards that will give you easy access to updates on submitted claims.
- Payment Posting: When a hospital or doctor’s office receives your ERAs (i.e., electronic remittance notices), enclosed checks, or direct deposits, the payments must also be posted. So don’t forget zero dollar remittances !
- Patient Payments: Once an ERA has been posted, the patient statement must also be submitted. You should also include all outstanding balances. Statements should also include the date of services provided, services provided, insurance reimbursement received, payments compiled at the time of service, and explanation of why the patient’s balance is owed.
- Denial Management: Denial or refund issues should be resolved as soon as they are received from insurers. Therefore, if a payer denies a claim, the ERA provides medical billers with a denial code and a quick explanation of the claim denial.
- Accounts Receivable Collections: Welcome to the final phase of medical billing! When it comes to patient collections, delinquent accounts can occur. Track patients who do not meet (i.e. pay) their patient financial responsibility after a set period of time.
- Credit balances: Last, but not least, are credit balances. While various events can cause a credit balance, medical billers must detect overpayments and promptly reimburse them to the correct parties. Failure to do so could result in consequences such as litigation, civil monetary fines, etc.
Equipment Needed for Medical Billing
Typically, suggested supplies for medical billing include, but are not limited to, the following items:
- A reliable computer
- Fax machine
- Printer
- Scanners
- Phone
Potential Risks or Complications of Medical Billing
It is vital that you perform medical billing tasks correctly. Errors that occur at any stage of the process can be quite costly in terms of revenue, administrative workload, and more. This highlights the need for well-trained medical billers who can successfully fulfill their role in the medical billing cycle. If you think about it, the financial well-being of a doctor’s practice or provider organizations depends on the effectiveness of the billing staff.
Pro Tips for Mastering the Art of Medical Billing
Here are some tips that may help you in the future.
- Make sure you understand the process. Think about it like this: How can you find a solution if you don’t understand the problem? When you need to troubleshoot the billing lifecycle, it is suggested that you first review the billing process and make sure you don’t have any questions. Broadly speaking, it can be divided into six parts:
- Confirm insurance eligibility
- Pick up the patient’s portion
- Share procedure and diagnosis codes for each patient visit
- Confirm selection of the appropriate code
- Enter claims into practice management software
- Get refund
- Try not to make assumptions. This probably goes without saying, but one of the biggest barriers to a smooth cash flow process is a patient who doesn’t make a payment. First things first: don’t assume that a patient always knows what amount he or she is supposed to pay. Some patients are not informed or may be confused about their insurance plans, co-pays, deductibles, etc.
- Know which method is best. Hint: The answer is usually electronic! Cash flow could be blocked if you use the wrong method or too many different ones. What do we mean by that? It is best not to bill a patient by mail, follow up by phone, and send late payments to a collection agency. Consistency is key here. Here are some suggestions to help you avoid these problems:
- Learn about patient payment responsibility before your appointment
- Regularly inform each patient of their payment responsibility
- Handle any services that require prior authorization before the patient arrives or as far in advance as possible
- Set clear expectations and maintain pricing transparency regarding your organization’s payment policy
- Post signs around your facilities indicating that state payments must be collected in advance
- Remember the big three. In the world of medical billing, your strongest allies against lost income are knowledge, mentorship, and practice. Once you fully understand your organization’s medical billing management Delaware process, it would be best to share that information with your coworkers in medical billing. It can also help them become experts. Most revenue delays are due to very preventable mistakes. A well-trained staff at the helm helps ensure that patients’ insurance policies are properly verified, proper co-pays are calculated, claims are submitted to insurers with accurate codes, etc.
- Be aware of the most common mistakes. A detail-oriented mindset is like kryptonite to errors in the medical billing process. Below are some of the most common errors found in insurance claims:
- Incorrect patient name and date of birth
- Incorrect address or contact information for supplier
- Incorrect payer ID and policy number (i.e. insurance information)
- Illegible handwritten documentation
- Claim Number Information is Missing on Appeals of Denied Claims
Why should medical assistants learn to perform medical billing tasks?
It is very beneficial for medical assistants to learn how to perform medical billing tasks. This is because medical billing is a key component to maintaining the financial health of each provider. Thanks to MA, MOA and other billing coders, doctors can maximize their time with each patient and better serve the public.