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Become a Medical Biller!
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If you have an interest in the medical field but prefer administrative work over direct patient care then medical billing and coding is perfect for you!

The Medical Biller

Medical Biller Steve Verno, an experienced independent medical billing business consultant, instructor and author has provided an interesting metaphor for us to understand what medical billing is all about. He said:

"Metaphorically speaking, medical billing is much like a river. It has deep parts and shallow parts. It can go straight or curve around bends. Its current can be slow and lazy or it can rush by so fast you have no control. It can be navigated, but carefully and cautiously. If you take a wrong turn, you can end up in deep water and up the creek without a paddle. If you don't heed the dangers, it can destroy you. The journey can be wondrous or boring. As the journey ends you can feel happy that you accomplished your goal, or you can arrive wet and miserable." ~ Steve Verno, Medical Biller

A medical biller is usually hired by a doctor, healthcare facility, medical group practice, or Health Maintenance Organization (HMO). They are hired as in-house employees, or outside consultants (independent, self-employed) for a doctor's medical claims processing and also, streamlining the facility's medical billing needs.

Duties typically include:

  • Medical billing processes
  • Medical Coding Levels 1, 2 and 3
  • Health insurance verification
  • Patient demographic registration
  • CPT, HCPCS and ICD-10
  • Charge entry
  • Claims submission (clearing house)
  • Payment posting
  • Account receivable follow up
  • Denial follow-up and settlement
  • Reporting
  • Compliance standards
  • HIPAA, Medicare, Medicaid, managed care, third party payers
  • Liability, workman's comp, preferred provider organizations and indemnity insurer's regulations

Most of the medical biller's days are spent at a computer desk in the claims processing office, the administrative billing and accounting department, or a private office, depending on the type and set up of the medical billing firm. The size of the facility, or amount of clients (licensed health care providers, practicing physicians) directly affects their weekly work load, but in general, most medical billers work 40 hours per week. Well trained and experienced medical billers posses the skills and ability to eventually become their own boss as a freelance medical billing service provider, or independent medical practice advisor from their own medical billing business.

Can medical billing be learned through home study?

The answer is yes and no. The medical billing process can be easy if you know what you are doing, however, self-training may only confuse you. Unless your self-study material is very well laid out and focused on the right areas you might get lost or overwhelmed, since it can be quite intricate. The best way to become proficient is through formal training where experts teach the necessary skills.

An experienced instructor can present medical procedure examples based on facts, present medical billing software they have actually used, and explain medical coding situations they have actually encountered, handled and know what is expected on the job. Example: CPT coding, which is an acronym for Current Procedural Terminology. CPT codes are published by the American Medical Association, and the fourth edition is the most current. The purpose of the coding system is to provide uniform language that accurately describes medical, surgical, and diagnostic services. While it can be extensive, it will provide the knowledge you need to handle the job most efficiently:

  • Medical terminology
  • Insurance terminology
  • Claim forms and claims process
  • EOBs
  • Aging reports
  • AR recovery
  • Coding basics
  • Data entry and software
  • Basic medical office management and admin

Medical billing training typically requires the following courses followed by a practicum:

  1. Medical terminology
  2. Human anatomy and physiology
  3. Pathology and Disease Processes
  4. Computer applications and data entry
  5. Typing and keyboarding
  6. CPT Coding
  7. ICD-10 coding
  8. Healthcare laws and ethics
  9. Health Information Management
  10. Health insurance policies

Your education does not end upon graduation from a formal training program, even for the best medical billers and coders education continues throughout their entire career.

The rules and regulations, billing procedures, coding system, Medicare rules, technology, research and laws in health care constantly change, and so, professionals in the medical billing and coding discipline will always have to continue learning, refreshing, revisiting and enhancing their skills. The best way to continue learning is through seminars, workshops, online webinars, continuing education programs, magazines and courses offered from various groups and medical office and billing software vendors. Some of the workshops and webinars are free, others are quite expensive, but in either case, they are important and well worth the money and time spent.

More Money With More Training?

As with any job, wages are commensurate with experience and can be higher, or lower in different locations. American Association of Professional Coders (AAPC) states the average starting salary for Certified Medical Coders is approximately $35,000 per year. Experienced professionals may eventually set up their own medical billing and coding consulting business and earn additional income for seminars, coding review analyses for providers and freelance consulting to payers. An independent consultant will try to make as much money as possible by investing their time and skills accordingly.

 

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