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The Claims Submission Process
When working from home...
 The word is "telecommute". The data necessary to submit claims for reimbursement will be downloaded from the medical office and processed by specialized computer software.
The program performs certain generic edits on the data and the sorts and stores the information. When a batch of claims is complete for an office, it is time to transmit it to the national clearinghouse. The data travels via modems and telephone lines to the clearinghouse where it is edited a second time.
This second series of edits incorporates health insurance specific rules and criteria. Participating insurance carriers notify the clearinghouse of certain edits they feel are necessary for approval. Once these edits are performed on each submitted claim they are verified and forwarded electronically to the carrier, thus guaranteeing accuracy and payment in most cases.
Upon receiving the insurance claim from the clearinghouse, the carriers check and finalize the claim and send payment directly to the health care provider. If done correctly physicians usually receive their money within three weeks. After that patients can be billed directly for any remaining co-payments or amounts the health insurance company did not cover. Some patients have secondary and supplementary health insurance policies. Their remaining balances are forwarded to there instead.
 Medical Billers Must Avoid Reimbursement DenialsWhen billing problems occur they will lead to complications, frustrations, and often serious complaints.
Billing problems are best avoided from the beginning!
The following are a few examples of typical medical billing and collections problems that can occur as a result of oversight and error, or sometimes incompetence. Many physicians, particularly Internists, are concerned about reimbursement for concurrent care when they see a patient in consultation on the same day as another internal medicine specialist or subspecialties.
List of Common Problems:
 Confusing and indecipherable bills Failure to follow consistent billing cycle, as stated in provider's policy Failure to credit payments Failure to deduct payments from balance owed Finance charges on billing mistakes/improper finance charges Improper filing of insurance/failure to file insurance Denial of care due to outstanding balance, even when balance is in dispute Denial of care to patients with "pre-paid" coverage, such as HMO members Denial of care to children of parents with outstanding balances Demanding payment in full from patients with previous bankruptcy filed against provider, even when patient has current health coverage; otherwise denying treatment Resurrecting old medical bills, from as long ago as 16 years Excessive rates for services; fees above "usual and customary" for many insurance companies Coercive and intimidating collection practices by Patient Accounts representatives Failure to honor payment agreements made with patients Unwillingness to put payment agreements in writing Improper notification to consumers that their accounts have been "flagged" for no service Refused requests for information and/or clarification of bills Overcharges/double-billing Charges for goods or services never received Upcoding -- billing for more complicated procedure than was performed Bills sent to inappropriate address or person Finance charges to Medicare patients Forcing patients with outstanding balances to get treatment at facilities in other counties Pushing patients to use credit cards or take out bank loans to pay medical bills in full immediately Charging HMO members improperly by calculating members' 20% co-pay based on the original full price, rather than on the HMO's discounted price Not understanding how patients reach their deductible and what portion of the payment goes to the deductible |
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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 experiencethrough NHA's Home Study Program |
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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.
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