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Work Area Challenges:

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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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Claims Processing Operations

While an increasing amount of patient care is being funded through HMO related insurance, where the patient makes a small copayment at the time of service and the doctor bills the managed care company for the balance, a number of patients still need to make arrangements to pay for their medical services over a period of time.

Confidentiality and Discretion

Incoming calls from patients with questions regarding a bill are also directed straight to the medical biller's office and from time to time patients must be contacted regarding a past due bill. Medical billers rely on excellent customer service skills when it comes to making contact with these patients, as well as insurance companies. When doing so they must be assertive, and communicate effectively without becoming confused when a client asks questions about billing statements.

The way the medical biller communicates over the phone explaining charges, dealing with criticism, giving and receiving feedback can make or break business relationships.

On February 16, 2006 the Health Insurance Portability and Accountability Act was finalized, and enacted. Medical billers and coders must know and adhere to this law which is designed to establish national standards for all health care transactions and to ensure the security and privacy of all health related information.

13 Steps Work Flow Chart:

1. Enter your patient information, adding new insurance carriers to your database as you go.

2. Enter the referral source or referring physician as well as any other information you've agreed to track for your clients.

3. Enter CPT and ICD-9 codes from the superbills and day sheets. Your software will automatically fill in the amounts charged for each procedure. Enter each charge on a separate line.

4. Transmit electronic claims directly to insurance carriers or to the clearinghouse.

5. Receive the audit report, review and correct errors on it.

6. Forward clean claims and resubmit rejected claims.

7. Print any paper claims.

8. Separate claims into your copy and the insurer's, fold and insert in envelopes.

9. Weigh envelopes that contain more than five claims to make sure you have sufficient postage.

10. Post payments to each patient's account. Most software programs include features that show which charges have been paid, how much is left on each charge and which charges are still unpaid.

11. Print aging reports so you can review each patient's account to determine which ones haven't been paid in a timely manner. Most software packages will do this for you.

12. Call insurance carriers to check on the status of delinquent claims. Most of your follow-up calls will be for paper claims.

13. Put your feet up and relax. You've earned a breather.

*This is according to the high-kicking Radio City Rockettes who described the medical claims specialist's daily bump and grind in a precision tap routine.

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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.