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Office Manager's Checklist:

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As you know, working medical coders and billers, as well as recent graduates from vocational training programs should seek certification as soon as possible to succeed!

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Importance of Properly Managing the Office

The person in charge of the medical office's billing and coding tasks provides invaluable services to the business and greatly contributes to its financial stability, cash flow, and success. The employer's livelihood depends on the medical office managers, and medical billing and coding staff.

First Things First!

The medical billing process starts long before the patient actually arrives for the appointment, and continues after the patient has been seen. Any delay in the process, and any inaccuracies, or miscommunications will lead to unwanted delays, and the longer it takes to get the claim out, the longer it takes to get paid!

Reminding Patients:

It is very important that insurance benefits are verified ahead of the patient's appointment time, and patients are called the day before the appointment to remind them to bring along all necessary documents, x-ray films, diagnostic reports, and referrals.

Patient No-Shows:

Should a patient fail to show for an appointment it must be promptly recorded in the patient's chart and the primary care physician (PCP) must be notified.

Day of the Appointment:

On the day of the appointment patients must complete a patient information sheet, or update their information if they have not been seen within the last six months, and read and sign the assignment of benefits and HIPAA forms. The patient's insurance and ID cards must be copied for the chart and all necessary information to produce a clean claim must be obtained before they are seen by the physician; failure to do so will delay payments for the claim.

Before the Patient Leaves:

Before the patient leaves the medical office the billing staff may collect any co-payments or go over established deferred payment arrangements with the patient. Remember:

Collect payment from the patient at the time of service

Set up payment plans in writing at the time of service

After the Appointment

After the examination the healthcare provider must immediately document all findings, treatments, and procedures that were provided into the patient's chart and onto the superbill form, also referred to as charge slip, charge sheet, or encounter form. Each procedure and diagnosis codes for services rendered must be carefully entered and matched.

Documenting the Visit

This cannot be done by any other medical office staff, only the healthcare provider (physician) is authorized to do this, otherwise it could lead to serious liability issues and consequences for the doctor if the staff enters the wrong diagnosis or charges for the wrong procedure!

Checking the Superbill

The medical coding staff can then go over the patient's chart and compare the superbill to make sure that the diagnosis codes match the specific procedures for accurate coding and reimbursement. Certain procedures require a detailed report to be attached to the claim form. It is important that the person who is responsible for reviewing and entering the data into a computer database is given accurate and complete information so it can be processed and possible omissions, or errors can be corrected.

Patient Billing

Medical offices that participate with health insurance plans are required to bill the insurance first then, after the EOB has been reviewed their billing staff sends an invoice for any remaining balance to the patient.

Patient's Advocate

A person, often a family member, who is designated to speak with healthcare providers on behalf of a patient. An advocate does not have legal powers, unlike a healthcare proxy.

Tips Regarding Deductible:

When it comes to the deductible, the patient's entire medical bill is used toward it (the deductible) until it is met.

For example:

If the patient has a $300 deductible and none of that deductible was met, and the total balance on the office visit bill was $150 the office collects $150 from the patient. As a result the patient has now met $150 of the deductible. Charges for the next office visit will be handled the same way until the deductible is paid completely. After the deductible is met, the insurance kicks in.

For example:

If the patient has a 80/20 insurance policy and a deductible of $300 after meeting 100 percent of the deductible ($300) the policy will pay 80% of the remaining balance and every subsequent medical bill.

Another example:

The patient sees the doctor and his bill is $500. He has a deductible of $300. This gets charged to the patient right off the bat.

Now that the deductible is met, the insurance company will cover 80% of the remaining balance ($500 total due - $300 deductible = $200 left) 80% of $200 is $160 (the insurance company's portion), and the patient is responsible the remaining 20% which is $40.

To sum it up, the patient paid the $300 deductible, plus his share of the copayment, a total of $340.

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Benefits of Medical Billing and Coding Certification... Countless job seekers face barriers to employment and promotion because they lack professional credentials! Certified professionals are more readily hired at higher pay than their non-certified counterparts. Since 1989 over 150,000 health care professionals have earned the recognition and rewards gained from passing NHA certification exams. By attaining certification they have joined a growing distinguished group of knowledgeable and expert health care professionals. NHA grants Certified Billing and Coding Specialist credentials to: new graduates based on their training working individuals based on experience through NHA's Home Study Program		Reasons Behind the High Demand For Medical Billers Medical, therapeutic, and pharmaceutical services play an important role in our nation's economy! Driven by the ever increasing need for medical services wherever there are people the opportunities in healthcare related disciplines never cease to exist. There is plenty of room for men and women in healthcare occupations as long as they have the drive to achieve their dreams. Employment is not limited by location, gender, race, religion, or even disability. Recruiters and employers are readily hiring qualified staff to better serve their patients and clients; this includes medical billers, whose job it is to make sure healthcare providers get paid for the medical services they have provided in their community.